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Bartels Y, Jekel M, Putschew A. Impact of the reductive deiodination on the sorption of iodinated X-ray contrast media to filter sand and activated carbon. WATER RESEARCH 2024; 258:121801. [PMID: 38810597 DOI: 10.1016/j.watres.2024.121801] [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: 10/14/2023] [Revised: 04/30/2024] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Abstract
Iodinated X-ray contrast media (ICM) and their aerobic transformation products (TPs) are widespread in the aquatic environment due to their persistent and mobile character. In a previous lab study, we have shown that the reductive (partial) deiodination of selected triiodobenzene derivatives increases the sorption to aquifer sand and loam soil, since iodine affects the compounds by steric hindrance, repulsive forces, resonance and inductive effects. These results suggest that the (partial) deiodination generally occurring to ICM and aerobic ICM TPs during anoxic/anaerobic bank filtration has a potential to increase their removal by sorption to natural sorbents. To basically assess the sorption potential to technically applied materials for drinking water treatment subsequent to bank filtration, we investigated the sorption of iopromide, diatrizoate and 5-amino-2,4,6-triiodoisophtalic acid and their di, mono and deiodinated structures to used filter sand from a waterworks and different fresh powdered activated carbons in batch tests using Berlin drinking water. The filter material, coated by iron and manganese oxides as well as organic material (including biofilm), preferentially removed monoiodinated derivatives, but diffusion through the organic layer heavily slowed the sorption. Therefore, the removal potential by sorption in rapid sand filters of waterworks for (partially) deiodinated benzene derivatives is suggested to be low. The deiodination of iopromide and diatrizoate significantly increased the sorption affinity to activated carbon and the competitiveness with regard to drinking water DOC. Despite the large atom radius of iodine, no clear correlation was found between the pore characteristics of the activated carbons and the molecular size of the compounds. This study emphasises the importance of anoxic/anaerobic conditions for the removal of persistent and mobile ICM and ICM TPs during drinking water treatment.
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Affiliation(s)
- Yuki Bartels
- Technische Universität Berlin, Faculty III Process Sciences, Institute of Environmental Technology, Chair of Water Quality Engineering, Strasse des 17. Juni 135 10623 Berlin, Germany
| | - Martin Jekel
- Technische Universität Berlin, Faculty III Process Sciences, Institute of Environmental Technology, Chair of Water Quality Engineering, Strasse des 17. Juni 135 10623 Berlin, Germany
| | - Anke Putschew
- Technische Universität Berlin, Faculty III Process Sciences, Institute of Environmental Technology, Chair of Water Quality Engineering, Strasse des 17. Juni 135 10623 Berlin, Germany.
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Chakeri Z, Nabipoorashrafi SA, Baruah D, Ballard DH, Chalian M, Mazaheri P, Hall NM, Desouches S, Chalian H. Contrast Reactions and Approaches to Staffing the Contrast Reaction Management Team. Acad Radiol 2024:S1076-6332(24)00354-4. [PMID: 38876842 DOI: 10.1016/j.acra.2024.05.042] [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: 01/19/2024] [Revised: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
RATIONALE AND OBJECTIVES Managing contrast reactions is critical as contrast reactions can be life-threatening and unpredictable. Institutions need an effective system to handle these events. Currently, there is no standard practice for assigning trainees, radiologists, non-radiologist physicians, or other non-physician providers for management of contrast reaction. MATERIALS AND METHODS The Association of Academic Radiologists (AAR) created a task force to address this gap. The AAR task force reviewed existing practices, studied available literature, and consulted experts related to contrast reaction management. The Society of Chairs of Academic Radiology Departments (SCARD) members were surveyed using a questionnaire focused on staffing strategies for contrast reaction management. RESULTS The task force found disparities in contrast reactions management across institutions and healthcare providers. There is a lack of standardized protocols for assigning personnel for contrast reaction management. CONCLUSION The AAR task force suggests developing standardized protocols for contrast reaction management. The protocols should outline clear roles for different healthcare providers involved in these events.
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Affiliation(s)
- Zahra Chakeri
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.)
| | - Seyed Ali Nabipoorashrafi
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.)
| | - Dhiraj Baruah
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA (D.B.)
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA (D.H.B., P.M.)
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.)
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA (D.H.B., P.M.)
| | - Neal M Hall
- Mercer University School of Medicine, Savannah, Georgia, USA (N.M.H.)
| | - Stephane Desouches
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA (S.D.)
| | - Hamid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA (Z.C., S.N., M.C., H.C.).
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Layer YC, Isaak A, Mesropyan N, Kupczyk PA, Luetkens JA, Dell T, Attenberger UI, Kuetting D. Image quality of abdominal photon-counting CT with reduced contrast media dose: Evaluation of reduced contrast media protocols during the COVID19 pandemic supply shortage. Heliyon 2024; 10:e28142. [PMID: 38533048 PMCID: PMC10963370 DOI: 10.1016/j.heliyon.2024.e28142] [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: 06/15/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Rationale and objectives Aim of this study was to assess the impact of contrast media dose (CMD) reduction on diagnostic quality of photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT). Methods CT scans of the abdominal region with differing CMD acquired in portal venous phase on a PCD-CT were included and compared to EID-CT scans. Diagnostic quality and contrast intensity were rated. Additionally, readers had to assign the scans to reduced or regular CMD. Regions-of-interest (ROIs) were placed in defined segments of portal vein, inferior vena cava, liver, spleen, kidneys, abdominal aorta and muscular tissue. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Results Overall 158 CT scans performed on a PCD-CT and 68 examinations on an EID-CT were analyzed. Overall diagnostic quality showed no significant differences for PCD-CT with standard CMD which scored a median 5 (IQR:5-5) and PCD-CT with 70% CMD scoring 5 (4-5). (For PCD-CT, 71.69% of the examinations with reduced CMD were assigned to regular CMD by the readers, for EID-CT 9.09%. Averaged for all measurements SNR for 50% CMD was reduced by 19% in PCD-CT (EID-CT 34%) and CNR by 48% (EID-CT 56%). Virtual monoenergetic images (VMI)50keV for PCD-CT images acquired with 50% CMD showed an increase in SNR by 72% and CNR by 153%. Conclusions Diagnostic interpretability of PCD-CT examinations with reduction of up to 50% CMD is maintained. PCD-CT deducted scans especially with 70% CMD were often not recognized as CMD reduced scans. Compared to EID-CT less decline in SNR and CNR is observed for CMD reduced PCD-CT images. Employing VMI50keV for CMD-reduced PCD-CT images compensated for the effects.
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Affiliation(s)
- Yannik C. Layer
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Patrick A. Kupczyk
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tatjana Dell
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrike I. Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Mehta A, Roa JA, Cannavale K, Sur S, Singh IP. Differences in radiopacity among CT contrast agents and concentrations: A quantitative study. J Neuroimaging 2023; 33:909-916. [PMID: 37626255 DOI: 10.1111/jon.13149] [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: 06/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND PURPOSE Several studies in the literature have attempted to subjectively assess the degree of visualization of different neurovascular structures using different contrast agents and concentrations. Given the recent contrast shortages, we aim to objectively compare the radiopacity achieved with four angiographic contrast agents used in clinical practice. METHODS Isovue 370, Visipaque 320, Omnipaque 300, and Isovue 300 were each drawn up at 25%, 50%, 75%, and 100% concentrations and compared against normal saline and air syringes. CT scans were obtained, and regions of interest were analyzed for radiopacity using Hounsfield unit (HU) measurements. An aneurysm model with different contrast concentrations was also scanned and dimensions compared. Two-tailed t-tests and Cohen's d coefficients were applied to assess for differences in mean HU measurements. RESULTS Isovue 370 and Isovue 300 had the highest and lowest mean HU, respectively (p < .001). Visipaque 320 at 25% concentration had the lowest mean HU at -.76. Statistically similar agents (p < .05) were Visipaque 320 and Omnipaque 300 at a 100% concentration (p = .30), and Omnipaque 300 and Isovue 300 at a 25% concentration (p = .73). Aneurysm dimensions among Isovue 370, Visipaque 320, and Omnipaque 300 were all similar, whereas with Isovue 300, the dimensions were significantly smaller (p < .05). CONCLUSION Isovue 370 provides the highest HU radiopacity and the most accurate aneurysm measurements. Angiographic measurements obtained with Isovue 300 may underestimate the actual aneurysmal dimensions. Visipaque 320 and Omnipaque 300 at 100% concentration have similar mean HUs and are beneficial for patients with chronic kidney or cardiac disease.
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Affiliation(s)
- Amit Mehta
- Department of Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jorge A Roa
- Department of Neuroendovascular Surgery, MedStar Franklin Square Hospital, Baltimore, Maryland, USA
| | - Kelly Cannavale
- Department of Neuroendovascular Surgery, MedStar Franklin Square Hospital, Baltimore, Maryland, USA
| | - Samir Sur
- Department of Neuroendovascular Surgery, MedStar Franklin Square Hospital, Baltimore, Maryland, USA
| | - I Paul Singh
- Department of Neurology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Ravn EJ, Hasific S, Thomassen M, Hjortebjerg R, Bach Laursen K, Diederichsen A, Bistrup C, Øvrehus KA. Intravenous versus oral hydration to reduce the risk of postcontrast acute kidney injury after intravenous contrast-enhanced CT in patients with severe chronic kidney disease (ENRICH): a study protocol for a single-centre, parallel-group, open-labelled non-inferiority randomised controlled trial in Denmark. BMJ Open 2023; 13:e074057. [PMID: 37699636 PMCID: PMC10503331 DOI: 10.1136/bmjopen-2023-074057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/07/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Contrast-enhanced CT (CECT) is widely used for diagnostic purposes. The use of contrast medium carries a risk for postcontrast acute kidney injury (PC-AKI), especially in patients with AKI or chronic kidney disease (CKD). Current guidelines recommend prophylactic intravenous hydration to prevent PC-AKI in high-risk patients. Oral hydration is non-inferior to intravenous hydration in patients with moderate CKD, but it has not been evaluated in high-risk patients. METHODS AND ANALYSIS The ENRICH trial will enrol 254 patients with estimated glomerular filtration rate ≤30 mL/min/1.73 m2 undergoing intravenous CECT, who are block randomised (2-4-2) with stratification for CKD stage, diabetes status, and indication for referral to prophylactic treatment with oral or intravenous hydration. PC-AKI is defined as an absolute increase in SCr of >0.3 mg/dL or >1.5 from baseline at 2-5 days. Renal function will also be evaluated <90 days, <7 days and 1-3 days before intravenous CECT, and 25-40 days after intravenous CECT. Secondary outcomes include dialysis, renal adverse events, hospitalisation due to hydration-related or contrast-related sequelae, and all-cause mortality ≤30 days postcontrast. Pre- and postcontrast plasma and urinary biomarkers will be evaluated for diagnostic and prognostic accuracy of the primary and secondary outcomes. ETHICS AND DISSEMINATION Oral hydration is patient-friendly and less costly compared with intravenous hydration. If oral hydration is non-inferior to intravenous hydration in high-risk patients, it could be implemented as new hydration strategy, which will facilitate the clinical diagnosing of elective patients with severe CKD without unnecessary resource utilisation. The protocol is approved by the Regional Scientific Ethical Committee for Southern Denmark (S-20210126), and the Data Protection Agency (21/66779). The study is conducted in accordance with the Declaration of Helsinki. Positive as well as negative findings will be reported in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05283512.
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Affiliation(s)
| | - Selma Hasific
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Clinical Genetics, University of Southern Denmark, Odense, Denmark
| | | | | | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Claus Bistrup
- Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
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Wang W, Song S, Liu W, Xia T, Du G, Zhai X, Jin B. Two-photon excited luminescence of structural light enhancement in subwavelength SiO 2 coating europium ion-doped paramagnetic gadolinium oxide nanoparticle and application for magnetic resonance imaging. DISCOVER NANO 2023; 18:85. [PMID: 37382861 DOI: 10.1186/s11671-023-03864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Oxides of lanthanide rare-earth elements show great potential in the fields of imaging and therapeutics due to their unique electrical, optical and magnetic properties. Oxides of lanthanide-based nanoparticles enable high-resolution imaging of biological tissues by magnetic resonance imaging (MRI), computed tomography (CT) imaging, and fluorescence imaging. In addition, they can be used to detect, treat, and regulate diseases by fine-tuning their structure and function. It remains challenging to achieve safer, efficient, and more sensitive nanoparticles for clinical applications through the structural design of functional and nanostructured rare-earth materials. RESULT In this study, we designed a mesoporous silica-coated core-shell structure of europium oxide ions to obtain near-infrared two-photon excitation fluorescence while maintaining high contrast and resolution in MRI. We designed enhanced 800 nm photoexcitation nanostructures, which were simulated by the finite-difference method (FDM) and finite-difference time-domain method (FDTD). The nanoparticle structure, two-photon absorption, up-conversion fluorescence, magnetic properties, cytotoxicity, and MRI were investigated in vivo and in vitro. The nanoparticle has an extremely strong optical fluorescence response and multiple excitation peaks in the visible light band under the 405 nm continuous-wave laser excitation. The nanoparticle was found to possess typical optical nonlinearity induced by two-photon absorption by ultrafast laser Z-scan technique. Two-photon excited fluorescence of visible red light at wavelengths of 615 nm and 701 nm, respectively, under excitation of the more biocompatible near-infrared (pulsed laser at 800 nm). In an in vitro MRI study, a T1 relaxation rate of 6.24 mM-1 s-1 was observed. MRI in vivo showed that the nanoparticles could significantly enhance the signal intensity in liver tissue. CONCLUSIONS These results suggest that this sample has applied potential in visible light fluorescence imaging and MRI.
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Affiliation(s)
- Wei Wang
- Medical Integration and Practice Center, Shandong University, Jinan, Shandong, China
| | - Shangling Song
- Medical Equipment Department, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Wendong Liu
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Tong Xia
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Gang Du
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xiangyu Zhai
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Bin Jin
- Department of Hepatobiliary Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.
- Organ Transplant Department, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Bartels Y, Jekel M, Putschew A. Can reductive deiodination improve the sorption of iodinated X-ray contrast media to aquifer material during bank filtration? CHEMOSPHERE 2023; 326:138438. [PMID: 36940829 DOI: 10.1016/j.chemosphere.2023.138438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
Iodinated X-ray contrast media (ICM) as well as their aerobic transformation products (TPs), are highly polar triiodobenzoic acid derivatives, ubiquitously found in the urban water cycle. Based on their polarity, their sorption affinity to sediment and soil is negligible. However, we hypothesize that the iodine atoms bound to the benzene ring play a decisive role for sorption, due to their large atom radius, high electron number and symmetrical positioning within the aromatic system. The aim of this study is to investigate, if the (partial) deiodination, occurring during anoxic/anaerobic bank filtration, improves the sorption to aquifer material. Tri, di, mono and deiodinated structures of two ICMs (iopromide and diatrizoate) and one precursor/TP of ICM (5-amino-2,4,6-triiodoisophtalic acid) were tested in batch experiments, using two aquifer sands and a loam soil with and without organic matter. The di, mono and deiodinated structures were produced by (partial) deiodination of the triiodinated initial compounds. The results demonstrated that the (partial) deiodination increases the sorption to all tested sorbents, even though the theoretical polarity increases with decreasing number of iodine atoms. Whereas lignite particles positively affected the sorption, mineral components decreased it. Kinetics tests show biphasic sorption for the deiodinated derivatives. We have concluded that iodine affects the sorption by sterical hindrance, repulsive forces, resonance and inductive effects, depending on the number and position of iodine, side chain characteristics and composition of the sorbent material. Our study has revealed an increased sorption potential of ICMs and their iodinated TPs to aquifer material during anoxic/anaerobic bank filtration as a result of (partial) deiodination, whereby a complete deiodination is not necessary for efficient removal by sorption. Furthermore, it suggests that the combination of an initial aerobic (side chain transformations) and a subsequent anoxic/anaerobic (deiodination) redox milieu supports the sorption potential.
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Affiliation(s)
- Yuki Bartels
- Technische Universität Berlin, Faculty III Process Sciences, Institute of Environmental Technology, Chair Water Quality Engineering, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Martin Jekel
- Technische Universität Berlin, Faculty III Process Sciences, Institute of Environmental Technology, Chair Water Quality Engineering, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Anke Putschew
- Technische Universität Berlin, Faculty III Process Sciences, Institute of Environmental Technology, Chair Water Quality Engineering, Strasse des 17. Juni 135, 10623 Berlin, Germany.
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Cheng X, Xia Y, Ji Q, Ji Q, Li H, Guo J, Li S, Yang S, Zhang L, He H. Occurrence and risk of iodinated X-ray contrast media in source and tap water from Jiangsu province, China. JOURNAL OF HAZARDOUS MATERIALS 2023; 444:130399. [PMID: 36403453 DOI: 10.1016/j.jhazmat.2022.130399] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/31/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
Microcontaminants in the water environment have received increasing attention due to their adverse effects on human health and wildlife. However, iodinated X-ray contrast media (ICM), a type of microcontaminants, have not yet been systematically documented in source and tap water. This study investigated ICM in water samples via a sampling activity from 25 drinking water sources and their corresponding 30 household taps in south-central Jiangsu Province, China. The total concentrations of ICM ranged from 14.2 to 138.5 ng/L in source water and 3.7 to 101.3 ng/L in tap water, respectively. The calculated average water treatment efficiency to remove ICM is 38.3% with large variation under different processes (ranging from 7.3% to 75.7%), which implied that ICM could not be effectively removed using current treatment technologies. By integrating other ICM into the predominant compound iohexol with relative potency factors, the health risks of total ICM through water consumption were assessed using the Monte Carlo simulation. The results concluded that the risk of ingesting ICM through tap water was not a major health concern for adults, teens, or children in the study area. Nevertheless, due to the lack of long-term toxicity data relevant for humans for ICM, this risk may be underestimated, which requires further research.
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Affiliation(s)
- Xinying Cheng
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Yubao Xia
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Qiuyi Ji
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Qingsong Ji
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Huiming Li
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Jiehong Guo
- Masonic Cancer Center, University of Minnesota at Twin Cities, Minneapolis, Minnesota 55455, USA; Department of Civil, Environmental, and Geospatial Engineering, Michigan Technological University, Michigan 49931, USA
| | - Shiyin Li
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Shaogui Yang
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China
| | - Limin Zhang
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China; Green Economy Development Institute, Nanjing University of Finance and Economics, Nanjing, Jiangsu 210023, P.R. China
| | - Huan He
- School of Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, P.R. China; College of Ecological and Resource Engineering, Fujian Provincial Key laboratory of Eco-Industrial Green Technology, Wuyi University, Wuyishan, Fujian 354300, P.R. China.
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Sullivan CM, Paul NS, Rieder MJ. Bridging the gap between bench and clinic: the importance of understanding the mechanism of iodinated contrast media hypersensitivity. Br J Radiol 2023; 96:20220494. [PMID: 36395475 PMCID: PMC10997019 DOI: 10.1259/bjr.20220494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Since the advent of CT, iodinated contract media (ICM) has become one of the most regularly administered intravenous medications in clinical settings. Although considered generally safe, ICM is one of the most common causes of adverse drug reactions in clinical practice, accounting for more than 2 million adverse reactions worldwide. Currently, there are few useful tools to diagnose patient hypersensitivity, with the major limitation being the lack of consensus regarding the mechanisms of hypersensitivity to ICM. While there is an overwhelming abundance of literature pertaining to clinical features including incidence, symptomatology, and risk, few studies have further investigated the underlying mechanisms behind their clinical observations. Of the available literature discussing pathophysiology, most primary studies were completed over 20 years ago, since which the molecular characteristics of ICM have changed. Furthermore, many reviews mentioning pathophysiology fail to adequately emphasize the clinical importance of understanding the molecular pathways involved in hypersensitivity. In this review, we aim to emphasize the clinical relevance of pathophysiology as it relates to the prediction and diagnosis of hypersensitivity reactions to ICM. To this end, we will first briefly characterize hypersensitivity reactions to ICM with respect to epidemiology and clinical presentation. We will then present the existing evidence supporting various proposed mechanisms of hypersensitivity, highlighting the gaps that remain in the mechanistic delineation of both immediate and delayed reactions. Finally, we discuss the possibility of in vitro testing as a way to predict and diagnose hypersensitivity reactions, pending a more complete elucidation of mechanisms.
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Affiliation(s)
- Caitlin M Sullivan
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
| | - Narinder S Paul
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
| | - Michael J Rieder
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
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Daniele G, Lafay F, Arnaudguilhem C, Mounicou S, Geffard A, Bonnard I, Dedourge-Geffard O, Bonnefoy C, Vulliet E. Evaluation of the accumulation of the iodinated contrast agents diatrizoic acid and iohexol in Dreissena polymorpha mollusks. CHEMOSPHERE 2023; 312:137153. [PMID: 36370762 DOI: 10.1016/j.chemosphere.2022.137153] [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: 07/28/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Mollusks are very sensitive to aquatic environmental alterations and then, are important bio-indicators for monitoring the contamination of water bodies. Iodinated X-ray contrast media (ICMs) are ubiquitously present in the aquatic environment, primarily due to their high consumption for diagnosis purposes, high injection levels, low biodegradability, and low removal rates by wastewater treatment plants. Although these compounds are assumed to be of low toxicity, aquatic organisms are continuously exposed to these agents, which may result in adverse effects as ICMs can act as iodine source and disrupt the endocrine system. Thus, the evaluation of their environmental risk, especially on aquatic fauna is of great interest. To this end, we first compared the accumulation behavior, based on iodine analysis, of two ICM exhibiting different osmolality, diatrizoic acid and iohexol in Dreissena polymorpha bivalves exposed under laboratory conditions at concentrations of 0, 100, and 1000 μg/L during 4 and 7 days. This study was the first to provide information on iodine concentration in whole soft tissues and several organs in control zebra mussels. Moreover, it showed, after exposure, an increase of iodine content mainly in the digestive glands, followed by gills and gonads, highlighting that ICMs actually enter the organisms. Thus, bioaccumulation of ICMs studies were then performed, by liquid chromatography coupled to tandem mass spectrometry, on entire mollusks and digestive glands of organisms exposed at 0, 10, 100, and 1000 μg/L of both ICMs during 21 days, followed by 4 days of depuration. These first data on ICMs concentrations in zebra mussels, showed a clear accumulation of ICMs in mussels as a function of relative exposure level, as well as a rapid depuration. Osmolality did not seem to have a significant impact on the accumulation level, but a slight difference was observed on the accumulation pattern between both ICMs.
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Affiliation(s)
- Gaëlle Daniele
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France.
| | - Florent Lafay
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
| | | | - Sandra Mounicou
- Université de Pau et des Pays de l'Adour, E2S UPPA, CNRS, IPREM, Pau, France
| | - Alain Geffard
- UMR-I 02 SEBIO (Stress Environnementaux et BIOsurveillance des Milieux Aquatiques), Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Campus Moulin de Housse, BP 1039, 51687, Reims, Cedex 2, France
| | - Isabelle Bonnard
- UMR-I 02 SEBIO (Stress Environnementaux et BIOsurveillance des Milieux Aquatiques), Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Campus Moulin de Housse, BP 1039, 51687, Reims, Cedex 2, France
| | - Odile Dedourge-Geffard
- UMR-I 02 SEBIO (Stress Environnementaux et BIOsurveillance des Milieux Aquatiques), Université de Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Campus Moulin de Housse, BP 1039, 51687, Reims, Cedex 2, France
| | - Christelle Bonnefoy
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
| | - Emmanuelle Vulliet
- Univ Lyon, CNRS, Université Claude Bernard Lyon 1, Institut des Sciences Analytiques, UMR 5280, 5 Rue de la Doua, F-69100, Villeurbanne, France
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11
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Muacevic A, Adler JR, Nasr I. Successful Desensitization to the Radiocontrast Material Iohexol (Omnipaque™). Cureus 2022; 14:e32356. [PMID: 36628042 PMCID: PMC9826696 DOI: 10.7759/cureus.32356] [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] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Adverse reactions to radiocontrast media (RCM) are rare and occur predominantly in association with intravenous administration but may also occur with intra-arterial and nonvascular injections (e.g., retrograde pyelography, intra-articular injections) of RCM. This article reports the case of a 52-year-old lady who was known to have amyloidosis secondary to rheumatoid arthritis and was on regular renal replacement therapy. She was under follow-up for regular angioplasties to manage the central vein stenosis that was affecting her right brachiocephalic arteriovenous fistula (AVF) and was referred to our Immunology service when she developed an allergic reaction after her AVF angioplasty (central venoplasty). Despite being dialysed immediately post-angioplasty, she complained of skin rash and itching with hoarseness of voice that developed almost six to eight hours post-angioplasty. We decided to arrange the iodinated non-ionic iso-osmolar contrast agent iodixanol (Visipaque™) for her instead, as it is known to be better tolerated in patients with reactions to Omnipaque™ due to its lower osmolarity as compared to Omnipaque™. However, since it was the first time to request this contrast in our hospital, it was not possible due to logistical reasons. It was necessary that our patient continued to undergo angioplasty every three months, however, she was developing more severe and earlier symptoms with each subsequent exposure to the radiocontrast medium. After her latest reaction of generalized itching and angioedema with shortness of breath during the procedure despite premedication, it was decided for her to undergo desensitization to Omnipaque™. In the absence of a published protocol for this, we used a protocol used for desensitization to Visipaque™. She showed an excellent response and completed her remaining angioplasties until Visipaque™ became available. Hence, desensitization to Omnipaque™ using the published protocol to Visipaque™ is likely to help patients allergic to Omnipaque™ or where Visipaque™ is not available or non-affordable in low/middle-income countries.
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12
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Evaluating the Image Quality of Neck Structures Scanned on Chest CT with Low-Concentration-Iodine Contrast Media. Tomography 2022; 8:2854-2863. [PMID: 36548531 PMCID: PMC9785131 DOI: 10.3390/tomography8060239] [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: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate and compare the image quality of low-concentration-iodine (240 mgI/mL) contrast media (CM) and high-concentration-iodine (320 mgI/mL) CM according to the radiation dose. METHODS A total of 366 CT examinations were examined. Based on an assessment of quantitative and qualitative parameters by two radiologists, the quality was compared between Group A (low-concentration-iodine CM) and Group B (high-concentration-iodine CM) images of thyroid gland, sternocleidomastoid muscle (SCM), internal jugular vein (IJV), and common carotid artery (CCA). Another subgroup analysis compared Group a, (using ≤90 kVp in Group A), and Group b, (using ≥100 kVp in Group B) for finding the difference in image quality when the tube voltage is lowered. RESULTS Image quality did not differ between Groups A and B or between Groups a and b. The signal-to-noise ratio and contrast-to-noise ratio were significantly higher for Group B than Group A for the thyroid gland, IJV, and CCA. No statistical differences were found in the comparison of all structures between Groups a and b. CONCLUSION There was no significant difference in image quality based on CM concentration with variable radiation doses. Therefore, if an appropriate CT protocol is applied, clinically feasible neck CT images can be obtained even using low-concentration-iodine CM.
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13
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Ding N, Liu X, Meng A, Zhao X, Ma G, Han W, Dong P, Li J, Zhou J. Manifesting viscosity changes in lipid droplets during iodined CT contrast media treatment by the real-time and in situ fluorescence imaging. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2022.107745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Kim SR, Son NH, Park HJ, Park KH, Park JW, Lee JH. Differences in the Recurrence Rate of Immediate Adverse Drug Reactions According to the Components of Alternative Contrast Media: Analysis of Repetitive Computed Tomography Cases in a Single Tertiary Hospital. Drug Saf 2022; 45:995-1002. [PMID: 35908149 DOI: 10.1007/s40264-022-01213-z] [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] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The recurrence rates of immediate adverse drug reactions (ADRs) to the alternative radiocontrast media (RCM) are not well known. Previous studies suggest selection of alternative RCM considering carbamoyl side chains; however, its usefulness for preventing the recurrence of ADRs has not been clearly verified. OBJECTIVE The aim of this study was to verify the recurrence rate of immediate ADRs according to the alternative RCM. METHOD This retrospective study analyzed 6420 contrast-enhanced computed tomography (CT) cases of 2009 patients registered in the ADR system from 861,664 CT cases in a single tertiary hospital between 2015 and 2020. Iohexol, iopromide, iobitridol, and iopamidol were used for CT. According to the carbamoyl side chains present, iohexol belongs to group 1, iopromide belongs to groups 1 and 2, iobitridol belongs to group 2, and iopamidol belongs to group 3. RESULTS Replacing iobitridol with iopamidol (odds ratio [OR] 2.595, 95% confidence interval [CI] 1.48-4.550) or iopromide (OR 3.354, 95% CI 1.420-7.926) as the subsequent RCM was associated with increased recurrence, while replacing iopamidol with iobitridol (OR 0.506, 95% CI 0.282-0.908) and iopromide with iohexol (OR 0.355, 95% CI 0.177-0.711) was associated with decreased recurrence. Other changes did not influence the recurrence of ADRs. CONCLUSIONS The recurrence of immediate ADRs increased in certain RCM combinations of preceding and subsequent CT scans, and the RCMs did not show cross-reactivity. Therefore, the clinical benefit of the alternative RCM considering cross-reactivity is limited. This result suggests that the side chains of RCM do not have an important role in the recurrence of immediate ADRs.
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Affiliation(s)
- Sung-Ryeol Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Kyounggi-do, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea.
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15
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Hu CY, Zhu YY, Xu B, Zhang TY, Lin YL, Xiong C, Wang QB, Huang DD, Xu L. Fe3O4 catalytic ozonation of iohexol degradation in the presence of 1-hydroxybenzotriazole: Performance, transformation mechanism, and pathways. Sep Purif Technol 2022. [DOI: 10.1016/j.seppur.2022.120810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Chompunud Na Ayudhya C, Ali H. Mas-Related G Protein–Coupled Receptor-X2 and Its Role in Non-immunoglobulin E–Mediated Drug Hypersensitivity. Immunol Allergy Clin North Am 2022; 42:269-284. [PMID: 35469618 PMCID: PMC9674431 DOI: 10.1016/j.iac.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A diverse group of Food and Drug Administration-approved cationic drugs including antibiotics, neuromuscular blocking drugs, opioids, antidepressants, and radiocontrast media activate mast cells and cause hypersensitivity reactions by both an immunoglobulin E IgE-dependent and independent manner. The recent discovery that these drugs activate mast cells via the G protein-coupled receptor known as Mas-related GPCR-X2 (MRGPRX2) has represented a paradigm shift of how drug hypersensitivity reactions are viewed. This article provides an overview of the current status of the role of MRGPRX2 on non-IgE-mediated drug hypersensitivity. Potential risk factors and evaluation for suspected MRGPRX2-mediated drug reactions are also discussed.
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Affiliation(s)
| | - Hydar Ali
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA 19104, USA.
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17
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18
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Cheng X, Ji Q, Wang X, Guo J, Chen X, He H, Yu N, Li S, Yang S, Zhang L. Determination of ten iodinated X-ray contrast media by solid-phase extraction and ultra-high performance liquid chromatography coupled with high-resolution orbitrap mass spectrometry. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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19
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Liang W, Yu CJ, Wang QY, Yu J. Anemia is associated with increased risk of contrast‑induced acute kidney injury: A Systematic Review and Meta-analysis. Bioengineered 2021; 12:648-661. [PMID: 33595423 PMCID: PMC8806332 DOI: 10.1080/21655979.2021.1883887] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Previous studies have identified numerous risk factors of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography. However, the association between anemia and CI-AKI remains conflicting. Thus, we conducted a meta-analysis to further clarify the relationship between anemia and CI-AKI. PubMed, EMBASE and Web of Science were systematically searched from inception to June 2020 to identify eligible studies. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to estimate the correlation between anemia and CI-AKI. The potential publication bias was estimated using funnel plot and Begg's test. A total of 13 studies (five case-control studies and eight cohort studies) comprising 27,135 patients were included. The pooled results showed that anemia was a significant risk factor of CI-AKI (OR, 1.82; 95% CI, 1.27-2.61). Moreover, the results of subgroup analyses and sensitivity analyses were basically consistent with the overall pooled result. Funnel plot and Begg's test indicated that there existed potential publication bias, but the result of trim and filled analysis showed that the pooled results kept stable after adding 'missing' studies. This meta-analysis suggested that anemia may be correlated with an increased incidence of CI-AKI in patients undergoing coronary angiography. However, our conclusions should be interpreted with caution due to some limitations. Therefore, further high-quality trials should be conducted to confirm our findings.
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Affiliation(s)
- Wei Liang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Cheng Jie Yu
- Medical Records Department, Lanzhou University First Hospital, Lanzhou University, Lanzhou, China
| | - Qiong Ying Wang
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jing Yu
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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20
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Brockow K. Diagnosing and Managing Patients with Reactions to Radiocontrast Media. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Purpose of the review
Iodinated radio contrast media (RCM) belong to the most common elicitors of drug hypersensitivity reactions (HR). Urticaria or anaphylaxis may occur ≤ 1(−6) hour(s) (immediate HR) and exanthems (non-immediate HR) develop > 6 h after application of RCM. Evidence for an immunologic mechanism of RCM HR against the different RCM benzene ring molecules and the benefit of allergological testing in patients with previous hypersensitivity reactions is progressively increasing.
Recent findings
Positive skin tests can confirm allergy in patients with previous reactions to RCM and help to select alternative better tolerated RCMs. Severe hypersensitivity reactions are mainly caused by an allergic mechanism, whereas the majority of non-severe reactions appear to be non-allergic. Skin testing is highly recommended to help identify allergic hypersensitivity reactions and to select alternatives. Using structurally different RCM is more effective than premedication for the prevention of future reactions. Drug provocation tests to RCM have been increasingly used, but are not yet standardized among different centers.
Summary
In patients with previous severe hypersensitivity reactions to RCM, skin testing is recommended. For future RCM-enhanced examinations in patients with previous reactions, structurally different, skin test-negative preparations should be applied. Drug provocation tests do confirm or exclude RCM hypersensitivity or may demonstrate tolerability of alternative RCMs.
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21
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Mescolotte GM, Silva FRD, Afonso S, Pamplona J, Moreno R. Reversible contrast-induced encephalopathy after coil embolization of epistaxis. Rev Bras Ter Intensiva 2021; 33:331-335. [PMID: 34231816 PMCID: PMC8275090 DOI: 10.5935/0103-507x.20210043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/12/2020] [Indexed: 12/04/2022] Open
Abstract
A 37-year-old woman (35 weeks pregnant) was admitted to a local hospital due to severe epistaxis resulting in shock and the need for emergency cesarean section. After failure to tamponade the bleeding, angiographic treatment was provided. After the procedure, she was admitted to the neurocritical intensive care unit and was confused and agitated, requiring sedation and endotracheal intubation. In the intensive care unit, diagnostic investigations included brain magnetic resonance imaging, lumbar puncture with viral panel, electroencephalogram, tests for autoimmunity, and hydroelectrolytic and metabolic evaluations. Magnetic resonance imaging showed a puntiform restricted diffusion area on the left corona radiata on diffusion weighted imaging and mild cortical posterior edema (without restricted diffusion), and an electroencephalogram showed moderate diffuse slow activity and fronto-temporal slow activity of the left hemisphere with associated scarce paroxysmal components. The other exams did not show any relevant alterations. Due to the temporal relationship, the clinical history and the magnetic resonance imaging results, a diagnosis of contrast-induced encephalopathy was made. After 2 days in the intensive care unit, sedation was withdrawn, the patient was extubated, and total neurological recovery was verified within the next 24 hours.
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Affiliation(s)
| | | | - Susana Afonso
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central - Lisboa, Portugal
| | - Jaime Pamplona
- Serviço de Neurorradiologia, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central - Lisboa, Portugal
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central - Lisboa, Portugal
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22
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Kim JH, Choi SI, Lee YJ, Kim BK, Park HW, Cho SH, Chang YS, Kim SH. Pharmacological prevention of delayed hypersensitivity reactions caused by iodinated contrast media. World Allergy Organ J 2021; 14:100561. [PMID: 34257798 PMCID: PMC8256281 DOI: 10.1016/j.waojou.2021.100561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 12/17/2022] Open
Abstract
Background Delayed hypersensitivity reactions (DHRs) to radiocontrast media (RCM) occur in approximately 0.5–23.0% of patients and are thought to be caused by T cell-mediated mechanisms. However, an optimal pharmacological preventive strategy is not yet established in patients with histories of delayed reactions to RCM. Objective We aimed to evaluate the efficacy of pharmacological prevention in patients with histories of delayed reactions to non-ionic low-osmolar RCM when re-exposed to RCM. Methods A retrospective review of electronic medical records of 117 patients with previous histories of DHRs to RCM who visited an allergy clinic for the prevention of reactions after the re-exposure to RCM was conducted. The effects of pharmacological prevention were compared according to the symptom scores of previous reactions based on their intensities and durations with electronic medical records (EMRs). Results Of the 117 patients who experienced DHRs after RCM injection, we confirmed the outcomes of RCM re-exposure in 101 patients. For pharmacological prevention, 92 patients (91.1%) received steroids before RCM injection and among them, 50 patients (49.5%) received additional steroids after RCM injection. With this pharmacological prevention, patients of symptoms improved or no recurrence, recurrence of similar previous symptoms, and recurrence of worse symptoms were 98 (97.0%), 2 (2.0%), and 1 (1.0%), respectively. The proportions of no recurrence after pharmacological prevention were lower in patients with severe reactions and higher symptom scores. Conclusion Pharmacological prevention showed a beneficial effect in most patients with delayed hypersensitivity to RCM. Further investigations are needed to establish an effective protocol for the prevention of delayed reactions to RCM.
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Affiliation(s)
- Jung-Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Internal Medicine, Korean Armed Forces Capital Hospital, Seongnam, South Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Byung-Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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23
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Yang J, Luo Y, Fu X, Dong Z, Wang C, Liu H, Jiang C. Unexpected degradation and deiodination of diatrizoate by the Cu(II)/S(IV) system under anaerobic conditions. WATER RESEARCH 2021; 198:117137. [PMID: 33957311 DOI: 10.1016/j.watres.2021.117137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/06/2021] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Transition metal catalyzed sulfite auto-oxidation is a promising technology used in water and wastewater treatment for the elimination of contaminants. In the literature, this process has been reported to be efficient only in the presence of oxygen. However, in this study, we unexpectedly found that the degradation of diatrizoate (DTZ) by a system based on the combination of copper ion and sulfite (Cu(II)/S(IV)) reached over 95% under anaerobic conditions, but was considerably retarded under aerobic conditions at pH 7. Furthermore, it was found that Cu(I), generated from the cleavage of the CuSO3 complex, was the main reactive species responsible for the degradation of DTZ by the Cu(II)/S(IV) system under anaerobic conditions. In fact, the absence of oxygen promoted the accumulation of Cu(I). The concomitant release of the iodide ion with the degradation of DTZ indicated that the anaerobic degradation of DTZ by the Cu(II)/S(IV) system mainly proceeded through the deiodination pathway, which was also confirmed by the detection of deiodinated products. The anaerobic degradation of DTZ was favored at higher initial concentrations of Cu(II) or sulfite in this system. Since the CuSO3 complex, the precursor of Cu(I), was formed mainly at pH 7, the highest anaerobic degradation of DTZ was achieved at pH 7. An increase in reaction temperature considerably enhanced the degradation of DTZ by the Cu(II)/S(IV) system with an apparent activation energy of 119.4 kJ/mol. The presence of chloride, bicarbonate and humic acid slightly influenced the anaerobic degradation of DTZ. The experiments with real water samples also demonstrated the effectiveness of the degradation of DTZ by the Cu(II)/S(IV) system under anaerobic conditions.
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Affiliation(s)
- Jingxin Yang
- Key Laboratory for Water Quality and Conservation of the Pearl River Delta, Ministry of Education, Institute of Environmental Research at Greater Bay,Guangzhou University, Guangzhou 510006, China
| | - Yujie Luo
- WISDRI City Construction Engineering &Research Incorporation Ltd, Xudong Street, Hongshan District,Wuhan 430223, China
| | - Xianghui Fu
- Key Laboratory for Water Quality and Conservation of the Pearl River Delta, Ministry of Education, Institute of Environmental Research at Greater Bay,Guangzhou University, Guangzhou 510006, China
| | - Zijun Dong
- Department of Building and Environmental Engineering, Shenzhen Polytechnic, Shenzhen 518055, China.
| | - Chuan Wang
- Key Laboratory for Water Quality and Conservation of the Pearl River Delta, Ministry of Education, Institute of Environmental Research at Greater Bay,Guangzhou University, Guangzhou 510006, China
| | - Hong Liu
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing 400714, China
| | - Chengchun Jiang
- Department of Building and Environmental Engineering, Shenzhen Polytechnic, Shenzhen 518055, China
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24
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Joseph JP, Domino P, Bird V, Sharma N, Ford S, Caruso LJ. Outcomes in patients with known contrast allergy undergoing contrast-enhanced endourological procedures: a retrospective cohort study. J Endourol 2021; 35:1857-1862. [PMID: 34088217 DOI: 10.1089/end.2021.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intravenous administration of iodinated contrast agents carries the risk of allergic reaction, yet this risk is unclear with administration into the urinary tract. We sought to evaluate patients with known contrast, iodine, or shellfish allergies for allergic response when undergoing urologic imaging requiring intraluminal, urinary tract contrast administration. MATERIALS AND METHODS We retrospectively reviewed consecutive patients undergoing endourologic procedures from 2010 to 2015 at our institution. Clinical records were reviewed for demographics, medical history, allergies, procedure details, fluids administered, anesthetic and pharmacologic agents administered, and continuous monitoring parameters. Patients with known allergies to iodine, shellfish, and/or contrast were identified and evaluated for clinical or hemodynamic signs of allergy. A convenience sample of 50 patients without allergy history was used as a comparison group. RESULTS We identified 1,405 procedures involving 1,000 consecutive patients. Procedures included retrograde pyelograms and antegrade nephrostograms. Eighty-six cases involving 58 patients with contrast, iodine, or shellfish allergies were identified. Of those with contrast allergy history, 18 (20.1%) cases involved patients with a history of anaphylactic reaction. Of these, 11 (61%) received steroid prophylaxis. No patients in either group (Allergy, No Allergy) were identified as having an allergic reaction during the procedure. There were no statistically significant differences in intraoperative intravenous fluids (p=0.931), procedure duration (p=0.747), or vasopressor use (p=0.973) between groups. Due to the zero event rate of contrast allergy, we used the Hanley and Lippman-Hand method, which places true population risk (95% confidence interval) of a significant event at less than 3.5%. CONCLUSIONS In 86 cases involving patients with a history of contrast allergy, we found no evidence of clinically significant allergic reaction to intraluminal endourologic contrast administration under continuous anesthesia monitoring. The risk of significant reactions to contrast administered within the urinary tract appears to be low in these patients, regardless of prophylaxis.
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Affiliation(s)
- Jason P Joseph
- University of Florida College of Medicine, 12233, Department of Urology, 1600 SW Archer Road, Gainesville, Florida, United States, 32610;
| | - Paula Domino
- University of Florida College of Medicine, 12233, Department of Urology, Gainesville, Florida, United States;
| | - Vincent Bird
- University of Florida College of Medicine, 12233, Department of Urology, Gainesville, Florida, United States;
| | - Nitin Sharma
- University of Florida College of Medicine, 12233, Department of Urology, Gainesville, Florida, United States;
| | - Susan Ford
- University of Florida College of Medicine, 12233, Department of Anesthesiology, Gainesville, Florida, United States;
| | - Lawrence J Caruso
- University of Florida College of Medicine, 12233, Department of Anesthesiology, Gainesville, Florida, United States;
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25
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Kim EY, Choi SJ, Ghim JL, Kim MY, Seol JE, Oh M, Park CS, Shin JG. Associations between HLA-A, -B, and -C alleles and iodinated contrast media-induced hypersensitivity in Koreans. Transl Clin Pharmacol 2021; 29:107-116. [PMID: 34235123 PMCID: PMC8255545 DOI: 10.12793/tcp.2021.29.e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/16/2021] [Accepted: 06/10/2021] [Indexed: 11/19/2022] Open
Abstract
A common cause of drug hypersensitivity reactions is iodinated contrast media (ICM). ICM-induced hypersensitivity had been considered to be a non-immunological reaction, but evidence for an immunological mechanism has increased recently. Thus, we evaluated whether HLA-A, -B, and -C alleles were associated with ICM-induced hypersensitivity. In total, 126 patients who underwent contrast-enhanced computed tomography studies through outpatient clinics at a tertiary referral hospital between 2008 and 2012 were assessed. Sixty-one patients experienced ICM-induced hypersensitivity and the remainder, 65, were ICM-tolerant patients (control). ICM-induced hypersensitivity patients showed 51 with immediate, 7 with non-immediate, 3 with both or mixed type. HLA-A, -B, and -C genotyping was performed using a PCR sequence-based typing method. Four kinds of ICM were used: iopromide, iohexol, iobitridol, and iodixanol. The most used ICM among the hypersensitivity patients was iopromide. Significant difference in the frequency of HLA-B*58:01 (odds ratios [OR], 3.90; p = 0.0200, 95% confidence interval [CI], 1.16-13.07) was observed between ICM-induced immediate hypersensitivity and control. There were statistically significant differences in the frequencies of the HLA-B*38:02 (OR, 10.24; p = 0.0145; 95% CI, 1.09-96.14) and HLA-B*58:01 (OR, 3.98; p = 0.0348; 95% CI, 1.03-15.39) between iopromide-induced immediate hypersensitivity and control. The mechanism of ICM-induced hypersensitivity remains unknown, but this study showed associations, although weak, with HLA-B*58:01 alleles for ICM-induced immediate hypersensitivity and HLA-B*38:02 and HLA-B*58:01 for iopromide-induced immediate hypersensitivity as risk predictors. Further studies are needed to validate the associations in larger samples and to identify the functional mechanism behind these results.
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Affiliation(s)
- Eun-Young Kim
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan 47392, Korea
- Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
| | - Seok Jin Choi
- Department of Radiology, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Jong-Lyul Ghim
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan 47392, Korea
- Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Jung Eun Seol
- Department of Dermatology, Inje University Busan Paik Hospital, Busan 47392, Korea
| | - Minkyung Oh
- Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
| | - Chan Sun Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan 48108, Korea
| | - Jae-Gook Shin
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan 47392, Korea
- Department of Pharmacology and Pharmacogenomics Research Center, Inje University College of Medicine, Busan 47392, Korea
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Li M, Zhang TY, Xu B, Hu CY, Dong ZY, Wang Z, Tang YL, Yu SL, Pan Y, Xian Q. Iodinated trihalomethanes formation in iopamidol-contained water during ferrate/chlor(am)ination treatment. CHEMOSPHERE 2021; 272:129568. [PMID: 33476791 DOI: 10.1016/j.chemosphere.2021.129568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/17/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
Iopamidol is a commonly used iodinated X-ray contrast media in medical field, and its residue in water can react with disinfectants to form highly toxic iodinated disinfection by-products (I-DBPs). This study investigated the degradation of iopamidol and formation of DBPs, especially iodinated trihalomethanes (I-THMs), during ferrate (Fe(VI)) pre-oxidation and subsequent chlor(am)ination under raw water background. It was found that iopamidol degradation efficiency in raw water by Fe(VI) at pH 9 could reach about 80%, which was much higher than that at pH 5 and pH 7 (both about 25%). With Fe(VI) dose increasing, iopamidol removal efficiency increased obviously. During the iopamidol degradation by Fe(VI), IO3- was the dominant product among all the iodine species. After pre-treated by Fe(VI), yields of THM4 and I-THMs can be reduced in subsequent chlor(am)ination. Besides, pH was a crucial factor for Fe(VI) pre-oxidition controlling DBPs. With the pH increasing from 5 to 9, the yield of THM4 kept increasing in subsequent chlorination but showed the highest amount at pH 6 in subsequent chloramination. The yield of I-THMs increased first and then decreased with the increase of pH in both subsequent chlorination and chloramination. I-THM concentrations in chlorinated samples were lower than chloraminated ones under acidic conditions but became higher under neutral and alkaline conditions. The total CTI of THMs during Fe(VI)-chloramination was higher than that during Fe(VI)-chlorination under neutral condition, but sharply decreased under alkaline conditions. In summary, Fe(VI)-chloramination subsequent treatment under alkaline conditions should be an effective method for iopamidol removal and DBP control.
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Affiliation(s)
- Mian Li
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China; College of Biological and Environmental Engineering, Guiyang University, Guiyang, 550005, PR China
| | - Tian-Yang Zhang
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai, 200092, PR China.
| | - Bin Xu
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai, 200092, PR China
| | - Chen-Yan Hu
- College of Environmental and Chemical Engineering, Shanghai University of Electric Power, Shanghai, 200090, PR China
| | - Zheng-Yu Dong
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China
| | - Zhen Wang
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China
| | - Yu-Lin Tang
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai, 200092, PR China
| | - Shui-Li Yu
- State Key Laboratory of Pollution Control and Resources Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai, 200092, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai, 200092, PR China
| | - Yang Pan
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing, 210023, PR China
| | - Qiming Xian
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing, 210023, PR China
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Bansie RD, Karim AF, van Maaren MS, Hermans MA, van Daele PLA, Gerth van Wijk R, Rombach SM. Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review. Int J Immunopathol Pharmacol 2021; 35:20587384211015061. [PMID: 34053316 PMCID: PMC8170298 DOI: 10.1177/20587384211015061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. METHODS A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. RESULTS Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%-9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%-34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. CONCLUSION In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.
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Affiliation(s)
- Rakesh D Bansie
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.,Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - A Faiz Karim
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands.,Department of Internal Medicine, Section Allergy and Clinical Immunology, Gouda Groene Hart Ziekenhuis, Zuid-Holland, the Netherlands
| | - Maurits S van Maaren
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Maud Aw Hermans
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Paul LA van Daele
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
| | - Saskia M Rombach
- Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus Medical Center, Rotterdam, Zuid-Holland, the Netherlands
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Sengar A, Vijayanandan A. Comprehensive review on iodinated X-ray contrast media: Complete fate, occurrence, and formation of disinfection byproducts. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 769:144846. [PMID: 33736235 DOI: 10.1016/j.scitotenv.2020.144846] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 05/22/2023]
Abstract
Iodinated contrast media (ICM) are drugs which are used in medical examinations for organ imaging purposes. Wastewater treatment plants (WWTPs) have shown incapability to remove ICM, and as a consequence, ICM and their transformation products (TPs) have been detected in environmental waters. ICM show limited biotransformation and low sorption potential. ICM can act as iodine source and can react with commonly used disinfectants such as chlorine in presence of organic matter to yield iodinated disinfection byproducts (IDBPs) which are more cytotoxic and genotoxic than conventionally known disinfection byproducts (DBPs). Even highly efficient advanced treatment systems have failed to completely mineralize ICM, and TPs that are more toxic than parent ICM are produced. This raises issues regarding the efficacy of existing treatment technologies and serious concern over disinfection of ICM containing waters. Realizing this, the current review aims to capture the attention of scientific community on areas of less focus. The review features in depth knowledge regarding complete environmental fate of ICM along with their existing treatment options.
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Affiliation(s)
- Ashish Sengar
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Arya Vijayanandan
- Department of Civil Engineering, Indian Institute of Technology Delhi, New Delhi 110016, India.
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HLA-DRB1*15: 02 Is Associated With Iodinated Contrast Media-Related Anaphylaxis. Invest Radiol 2021; 55:304-309. [PMID: 31985601 DOI: 10.1097/rli.0000000000000644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of severe reaction induced by iodinated contrast media (ICM) has increased over the years with an increasing use of imaging modalities. Although ICM anaphylaxis is rare, it can be life-threatening, but currently, there is no biomarker that can identify individuals at risk of ICM anaphylaxis. OBJECTIVE The aim of this study is to investigate the genetic susceptibility of ICM anaphylaxis. METHODS Patients who had ICM anaphylaxis were enrolled in the study, and their blood samples were collected for genotyping of human leukocyte antigen (HLA)-A, -B, -C, and -DR. The results were compared with those of healthy Korean general population. MRGPRX2 gene in ICM anaphylaxis group was also sequenced and compared with the Korean standard database of genetic polymorphism. RESULTS The frequencies of 3 HLA alleles (B*52:01, C*12:02, and DRB1*15:02) were significantly higher in 47 patients with ICM anaphylaxis. In particular, HLA-DRB1*15:02 was 5 times more frequent in the ICM anaphylaxis group than the Korean general population (34.0% vs 6.6%; odds ratio, 7.306; 95% confidence interval, 3.622-14.740), and this difference was most pronounced in subjects with iohexol-induced anaphylaxis (odds ratio, 16.516; 95% CI, 5.241-52.047; P < 0.0001). Eight single nucleotide polymorphisms were identified in MRGPRX2 gene, but their frequencies were not different in those with ICM anaphylaxis compared with the general Korean population. CONCLUSIONS HLA-DRB1*15:02 is associated with ICM anaphylaxis in the Korean population.
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30
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Chen G, Liu B, Chen S, Li H, Liu J, Mai Z, Chen E, Zhou C, Sun G, Guo Z, Lei L, Huang S, Zhang L, Li M, Tan N, Li H, Liao Y, Liu J, Chen J, Liu Y. Novel biomarkers for post-contrast acute kidney injury identified from long non-coding RNA expression profiles. Int J Biol Sci 2021; 17:882-896. [PMID: 33767596 PMCID: PMC7975710 DOI: 10.7150/ijbs.45294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Post-contrast acute kidney injury (PC-AKI) is a severe complication of cardiac catheterization. Emerging evidence indicated that long non-coding RNAs (lncRNAs) could serve as biomarkers for various diseases. However, the lncRNA expression profile and potential biomarkers in PC-AKI remain unclear. This study aimed to investigate novel lncRNA biomarkers for the early detection of PC-AKI. Methods: lncRNA profile in the kidney tissues of PC-AKI rats was evaluated through RNA sequencing. Potential lncRNA biomarkers were identified through human-rat homology analysis, kidney and blood filtering in rats and verified in 112 clinical samples. The expression patterns of the candidate lncRNAs were detected in HK-2 cells and rat models to evaluate their potential for early detection. Results: In total, 357 lncRNAs were found to be differentially expressed in PC-AKI. We identified lnc-HILPDA and lnc-PRND were conservative and remarkably upregulated in both kidneys and blood from rats and the blood of PC-AKI patients; these lncRNAs can precisely distinguish PC-AKI patients (area under the curve (AUC) values of 0.885 and 0.875, respectively). The combination of these two lncRNAs exhibited improved accuracy for predicting PC-AKI, with 100% sensitivity and 83.93% specificity. Time-course experiments showed that the significant difference was first noted in the blood of PC-AKI rats at 12 h for lnc-HILPDA and 24 h for lnc-PRND. Conclusion: Our study revealed that lnc-HILPDA and lnc-PRND may serve as the novel biomarkers for early detection and profoundly affect the clinical stratification and strategy guidance of PC-AKI.
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Affiliation(s)
- Guanzhong Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
| | - Bowen Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
| | - Huanqiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Ziling Mai
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
| | - Enzhao Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Chunyun Zhou
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
| | - Zhaodong Guo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Li Lei
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shanyi Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Liyao Zhang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Min Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Hong Li
- Guangzhou Jingke Bioscience Center, Guangzhou, 510006, Guangdong, China
| | - Yulin Liao
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838, Guangzhou Avenue North, Guangzhou 510515, China
| | - Jia Liu
- School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510000, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
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Navarro Triviño FJ, Linares-González L, Ródenas-Herranz T, Llamas-Molina JM, Ruiz-Villaverde R. Acute localized exanthematous pustulosis (ALEP) induced by iomeprol (Iomeron 350): A diagnostic challenge. Contact Dermatitis 2021; 85:95-97. [PMID: 33474760 DOI: 10.1111/cod.13790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Francisco J Navarro Triviño
- Department of Contact Eczema and Immunoallergic Diseases, Dermatology, Hospital Universitario San Cecilio, Granada, Spain
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Jo EJ, Park HK. Effects of an electronic system for the management of adverse reactions to iodinated contrast media. ALLERGY ASTHMA & RESPIRATORY DISEASE 2021. [DOI: 10.4168/aard.2021.9.3.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eun-Jung Jo
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
| | - Hye-Kyung Park
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea
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Lohana AC, Neel S, Deepak V, Schauer M. Intrathecal iodinated contrast-induced transient spinal shock. BMJ Case Rep 2020; 13:13/12/e237610. [PMID: 33370945 DOI: 10.1136/bcr-2020-237610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Transient spinal shock is a previously unreported complication of intrathecal contrast. A 63-year-old man presented with the chief complaint of worsening back pain. Computed topography of lumbar spine without contrast showed a lytic lesion. After international normalized ratio (INR) correction, patient was sent for CT myelogram. After intrathecal contrast injection, the patient dropped his blood pressure profoundly and developed clinical manifestations of spinal shock. Emergent intravenous bolus fluids were initiated resulting in improvement in blood pressure. Patient's spinal shock resolved within hours. CT myelogram was normal except previously known lytic lesion. It was concluded that the transient shock was most likely due to contrast injection. We believe that this is the first reported case of transient spinal shock following CT myelogram using water-soluble iodinated non-ionic contrast agent administered intrathecally.
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Affiliation(s)
| | - Sejal Neel
- Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan
| | - Vishal Deepak
- Pulmonary and Critical Care Medicine, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Mark Schauer
- Internal Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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Nijssen EC, Rennenberg R, Nelemans P, van Ommen V, Wildberger JE. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. ROFO-FORTSCHR RONTG 2020; 193:151-159. [PMID: 33327033 DOI: 10.1055/a-1248-9178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite tremendous improvement in molecular properties over the last century, intravascular injection of iodinated contrast material may still have systemic and hemodynamic consequences. Patients with pre-existing renal insufficiency may be at risk for acute kidney injury, which may be associated with an increased risk of the need for dialysis and mortality in the long term. Many questions as to the physiological pathways, optimal definition, and incidence of contrast-induced acute kidney injury remain open. These uncertainties are reflected in the changing landscape of this field in terms of nomenclature, research, and clinical practice. METHODS Clinical practice guidelines for the prevention of post-contrast acute kidney injury all recommend giving prophylaxis in the form of intravenous hydration to high-risk patients. Solid evidence for this strategy is lacking. This article gives an overview of the changing landscape of post-contrast acute kidney injury and prophylactic intravenous hydration, with the aim of supporting informed decision-making in clinical practice. RESULTS Recent data have caused a shift in guideline recommendations: 90 % of patients formerly considered high-risk for contrast-induced acute kidney injury no longer qualify for prophylaxis. The remaining high-risk patients, with severe chronic kidney disease, represent a vulnerable population for whom intravenous hydration may provide some benefits but also carries risk. CONCLUSION Intravenous hydration may benefit 'new' high-risk patients. However, it also confers risk. A dual approach to screening patients will help avoid this risk in clinical practice. KEY POINTS · Intravenous hydration is the cornerstone for preventing contrast-induced acute kidney injury. · Solid evidence is lacking; recent data caused a shift in guideline recommendations. · Intravenous hydration may benefit 'new' high-risk patients with severe chronic kidney disease; however, it also confers risk. · A dual approach to screening patients will help avoid this risk in clinical practice. CITATION FORMAT · Nijssen E, Rennenberg R, Nelemans P et al. Post-Contrast Acute Kidney Injury and Intravenous Prophylactic Hydration: An Update. Fortschr Röntgenstr 2021; 193: 151 - 159.
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Affiliation(s)
- Estelle Claire Nijssen
- Radiology & Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Roger Rennenberg
- Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Patty Nelemans
- Epidemiology, Maastricht University, Maastricht, Netherlands
| | - Vincent van Ommen
- Cardiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Joachim E Wildberger
- Radiology & Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
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Jeong Y, Shin H, Na K. Facile Hydrothermal Synthesis of an Iodine-Doped Computed Tomography Contrast Agent Using Insoluble Triiodobenzene. ACS Biomater Sci Eng 2020; 6:6961-6970. [PMID: 33320597 DOI: 10.1021/acsbiomaterials.0c01131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Carbonized iodine-doped particles (CIPs) were developed to overcome the disadvantages of computed tomography (CT) contrast agents, such as high osmolality and the radiodensity dilution of monomolecular contrast agents and low solubility and high toxicity of polymeric contrast agents. The CIPs were synthesized via a hydrothermal synthesis for 8 h using ATIPA (5-amino-2,4,6-triiodoisophthalic acid), glycerol, and tromethamine in the presence of D.W. (deionized water)-insoluble ATIPA converted into CIPs through a hydrothermal synthesis, showing high solubility and low osmotic pressure. The in vitro contrast effect determined for the resulting CIPs demonstrated a 57.6% enhancement compared to iohexol, and the osmotic pressure of the resulting CIPs was lower than that of iohexol. In addition, the CIPs demonstrated no dilution-induced contrast decrease in plasma and, therefore, demonstrated high contrast strength in vivo. Cytotoxicity tests, hemolysis assays, and histological analyses were conducted to verify the biocompatibility of the CIP product; however, no toxicity was observed. Furthermore, the CIP demonstrated a much higher contrast effect than iohexol at low concentrations. These results indicate that the CIP we have produced may be used as an effective blood pool agent for CT imaging.
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Affiliation(s)
- Yohan Jeong
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi do 14662, Republic of Korea
| | - Heejun Shin
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi do 14662, Republic of Korea
| | - Kun Na
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Wonmi-gu, Bucheon-si, Gyeonggi do 14662, Republic of Korea
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Notohamiprodjo S, Treitl KM, Hauke C, Sutter SM, Auweter S, Pfeiffer F, Reiser MF, Hellbach K. Imaging characteristics of intravascular spherical contrast agents for grating-based x-ray dark-field imaging – effects of concentrations, spherical sizes and applied voltage. Sci Rep 2020; 10:9405. [PMID: 32523085 PMCID: PMC7287139 DOI: 10.1038/s41598-020-66395-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/14/2020] [Indexed: 11/09/2022] Open
Abstract
AbstractThis study investigates the x-ray scattering characteristics of microsphere particles in x-ray-grating-based interferometric imaging at different concentrations, bubble sizes and tube voltages (kV). Attenuation (ATI), dark-field (DFI) and phase-contrast (PCI) images were acquired. Signal-to-noise (SNR) and contrast-to-noise ratios with water (CNRw) and air as reference (CNRa) were determined. In all modalities, a linear relationship between SNR and microbubbles concentration, respectively, microsphere size was found. A significant gain of SNR was found when varying kV. SNR was significantly higher in DFI and PCI than ATI. The highest gain of SNR was shown at 60 kV for all media in ATI and DFI, at 80 kV for PCI. SNR for all media was significantly higher compared to air and was slightly lower compared to water. A linear relationship was found between CNRa, CNRw, concentration and size. With increasing concentration and decreasing size, CNRa and CNRw increased in DFI, but decreased in PCI. Best CNRa and CNRw was found at specific combination of kV and concentration/size. Highest average CNRa and CNRw was found for microspheres in ATI and PCI, for microbubbles in DFI. Microspheres are a promising contrast-media for grating-based-interferometry, if kV, microsphere size and concentration are appropriately combined.
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Oral premedication in patients with a history suggesting hypersensitivity to iodinated contrast media. Postepy Dermatol Alergol 2020; 37:520-523. [PMID: 32994773 PMCID: PMC7507170 DOI: 10.5114/ada.2020.98269] [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: 08/01/2018] [Accepted: 01/01/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Iodinated contrast media (ICM) are pharmaceuticals widely used in diagnostic procedures. Adverse effects associated with their administration are quite frequent and mostly mild. However, they raise concerns in patients and doctors in the context of their future use. Aim To determine efficacy of premedication before medical procedures with the use of iodinated contrast media in patients with a history suggesting a hypersensitivity reaction after their past use. Material and methods Out of 152 patients consulted due to adverse reactions after ICM (85 women and 67 men, aged 43–90), 101 were selected with the history suggesting a mild hypersensitivity reaction (urticaria, itching, skin redness, malaise etc.). All the patients had health problems requiring a procedure with ICMadministration in the near future. The premedication was given with cetirizine (10 mg) and prednisone (20 mg or 50 mg, randomly assigned) 13, 7 and 1 h before the ICM administration. Presence of adverse events was compared between the subgroups with χ2 test and efficacy of premedication – with Wilcoxon test. Results Seventy-six patients underwent the radiologic procedure with premedication with antihistamine and a lower (40 patients) or higher dose (36 patients) of prednisone. Four of them reported a cutaneous hypersensitivity reaction (urticaria, itching, redness) and one – dyspnoea. There was no statistically significant difference in relation to the premedication protocol (p = 0.1306). Conclusions Premedication with cetirizine and prednisone before radiologic procedures proved to be efficient in patients with a history suggesting hypersensitivity to iodinated contrast media. There was no significant difference in efficacy related to the dose of prednisone (20 mg vs. 50 mg).
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He H, Wang W, Xu C, Yang S, Sun C, Wang X, Yao Y, Mi N, Xiang W, Li S, Liu G. Highly efficient degradation of iohexol on a heterostructured graphene-analogue boron nitride coupled Bi 2MoO 6 photocatalyst under simulated sunlight. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 730:139100. [PMID: 32380369 DOI: 10.1016/j.scitotenv.2020.139100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
Iohexol (IOH), as a typical iodinated X-ray contrast media (ICMs) with potential threat to human health, is difficult to be removed with the conventional wastewater treatment methods. In this work, new boron nitride coupled Bi2MoO6 layered microspheres (BN/Bi2MoO6) composites were applied to remove IOH from water via photocatalytic degradation. The degradation constant kapp of IOH over 3.5 wt% BN/Bi2MoO6 was 0.016 min-1, which was 3.2 times that of Bi2MoO6 (0.005 min-1). The degradation rate of IOH on 3.5 wt% BN/Bi2MoO6 reached 92% in 150 min. The enhanced photocatalytic activity of BN/Bi2MoO6 can be attributed to the heterojunction between BN and Bi2MoO6. The matched type-I band alignment heterojunction of two semiconductors prominently improved the charge separation. Based on the trapping experiments, holes and superoxide radicals were proved to be the main active species for photocatalytic IOH degradation. Besides, the degradation products of IOH were analyzed by LC-HRMS and the possible degradation mechanism of IOH was also proposed in this work.
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Affiliation(s)
- Huan He
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Wei Wang
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China; School of the Geography, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Chenmin Xu
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Shaogui Yang
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China.
| | - Cheng Sun
- State Key Laboratory of Pollution Control and Resources Reuse, School of the Environment, Nanjing University, Nanjing, Jiangsu 210023, PR China
| | - Xiaohan Wang
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Youru Yao
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Na Mi
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Weiming Xiang
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China
| | - Shiyin Li
- School of the Environment, Nanjing Normal University, Nanjing, Jiangsu 210023, PR China.
| | - Guo Liu
- Chengdu University of Technology, Key Lab Geohazard Prevent & Geoenvironm Protect, Chengdu, Sichuan 610059, PR China
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Khan NA, Ahmed S, Farooqi IH, Ali I, Vambol V, Changani F, Yousefi M, Vambol S, Khan SU, Khan AH. Occurrence, sources and conventional treatment techniques for various antibiotics present in hospital wastewaters: A critical review. Trends Analyt Chem 2020. [DOI: 10.1016/j.trac.2020.115921] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Imberti C, Fedatto Abelha T, Yan Y, Lange J, Cui X, Szanda I, Goh V, Dailey LA, T M de Rosales R. Synthesis and in vivo evaluation of PEG-BP-BaYbF 5 nanoparticles for computed tomography imaging and their toxicity. J Mater Chem B 2020; 8:7723-7732. [PMID: 32725026 PMCID: PMC8693452 DOI: 10.1039/d0tb00969e] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Computed tomography (CT) is one of the most widespread imaging techniques in clinical use worldwide. CT contrast agents are administered to improve soft tissue contrast and highlight blood vessels. However, the range of CT contrast agents available in the clinic is limited and they suffer from short-circulation times and low k-edge values that result in the need for high doses for in vivo applications. Nanomaterials containing a mixture of electron-dense elements, such as BaYbF5 nanoparticles, have shown promise as more efficient CT contrast agents, but they require biocompatible coatings for biomedical applications. Here, we explore the use of a bifunctional PEG polymer (5 kDa) containing a terminal bisphosphonate (BP) anchor for efficient binding to the surface of BaYbF5 nanomaterials. The resulting PEG(5)-BP-BaYbF5 nanoparticles were synthesized and characterized using TEM, DLS, TGA, XRD and Z-potential measurements. Their in vitro stability was verified and their ability to produce CT contrast in a wide range of X-ray energies, covering preclinical and clinical scanners, was demonstrated. In vitro toxicity studies with PEG(5)-BP-BaYbF5 in the phagocytic pro-monocytic human cell line U937 did not identify toxic effects, even at high concentrations (30 mM). In vivo, PEG(5)-BP-BaYbF5 exhibited efficient CT contrast for angiography imaging, highlighting blood vessels and vascular organs, and long circulation times as expected from the PEG coating. However, at late time points (48 h), in vivo toxicity was observed. While the causes could not be completely elucidated, in vitro studies suggest that decomposition and release of Yb3+ and/or Ba2+ metal ions after decomposition of PEG(5)-BP-BaYbF5 may play a role. Overall, despite the promising CT contrast properties, our results suggest that BaYbF5 nanomaterials may suffer from significant long-term toxicities.
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Affiliation(s)
- Cinzia Imberti
- Department of Imaging Chemistry & Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH, UK.
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Vega F, Múgica MV, Argíz L, Bazire R, Belver MT, Friera A, Blanco C. Protocol to prevent contrast-induced nephropathy in parenteral challenge tests for allergy evaluation of hypersensitivity reactions to iodinated contrast media. Clin Exp Allergy 2020; 50:1200-1203. [PMID: 32654204 DOI: 10.1111/cea.13709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Francisco Vega
- Department of Allergy, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Maria Victoria Múgica
- Department of Allergy, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Laura Argíz
- Department of Allergy, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Raphaëlle Bazire
- Department of Allergy, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Maria Teresa Belver
- Department of Allergy, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Alfonsa Friera
- Department of Radiology, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
| | - Carlos Blanco
- Department of Allergy, Instituto de Investigacion Sanitaria Princesa (IP), Hospital Universitario de la Princesa, Madrid, Spain
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Ter Voert CEM, Kour RYN, van Teeffelen BCJ, Ansari N, Stok KS. Contrast-enhanced micro-computed tomography of articular cartilage morphology with ioversol and iomeprol. J Anat 2020; 237:1062-1071. [PMID: 32683740 DOI: 10.1111/joa.13271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 11/29/2022] Open
Abstract
Non-ionic, low-osmolar contrast agents (CAs) used for computed tomography, such as Optiray (ioversol) and Iomeron (iomeprol), are associated with the reduced risk of adverse reactions and toxicity in comparison with ionic CAs, such as Hexabrix. Hexabrix has previously been used for imaging articular cartilage but has been commercially discontinued. This study aimed to evaluate the efficacy of Optiray and Iomeron as alternatives for visualisation of articular cartilage in small animal joints using contrast-enhanced micro-computed tomography (CECT). For this purpose, mouse femora were immersed in different concentrations (20%-50%) of Optiray 350 or Iomeron 350 for periods of time starting at five minutes. The femoral condyles were scanned ex vivo using CECT, and regions of articular cartilage manually contoured to calculate mean attenuation at each time point and concentration. For both CAs, a 30% CA concentration produced a mean cartilage attenuation optimally distinct from both bone and background signal, whilst 5-min immersion times were sufficient for equilibration of CA absorption. Additionally, plugs of bovine articular cartilage were digested by chondroitinase ABC to produce a spectrum of glycosaminoglycan (GAG) content. These samples were immersed in CA and assessed for any correlation between mean attenuation and GAG content. No significant correlation was found between attenuation and cartilage GAG content for either CAs. In conclusion, Optiray and Iomeron enable high-resolution morphological assessment of articular cartilage in small animals using CECT; however, they are not indicative of GAG content.
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Affiliation(s)
- Colet E M Ter Voert
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - R Y Nigel Kour
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - Bente C J van Teeffelen
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - Niloufar Ansari
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Vic., Australia
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Seibert FS, Heringhaus A, Pagonas N, Rudolf H, Rohn B, Bauer F, Timmesfeld N, Trappe HJ, Babel N, Westhoff TH. Biomarkers in the prediction of contrast media induced nephropathy - the BITCOIN study. PLoS One 2020; 15:e0234921. [PMID: 32673348 PMCID: PMC7365403 DOI: 10.1371/journal.pone.0234921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background Subjects with chronic kidney disease are at increased risk for contrast-induced acute kidney injury (CI-AKI). Risk stratification is traditionally based on glomerular filtration rate (GFR) and proteinuria. The present trial examines, whether tubular and inflammatory biomarkers are able to identify subjects at increased risk as well. Methods We performed a prospective study in 490 patients undergoing coronary angiography. An increase of serum creatinine concentration ≥ 0.3 mg/dl from baseline to day 2–3 was defined as primary endpoint (CI-AKI). Urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and calprotectin were assessed < 24h before coronary angiography. Prognostic accuracy was assessed by receiver operating characteristics (ROC) calculations. Results 30 (6.1%) patients suffered from CI-AKI (27 AKIN stage I, 3 AKIN stage II, 0 AKIN stage III). Those subjects who developed CI-AKI had 3.1 fold higher baseline urinary NGAL/creatinine ratios than those without CI-AKI (60.8 [IQR 18.7–93.1] μg/mg vs. 19.9 [IQR 12.3–38.9] μg/mg, p = 0.001). In those subjects without clinically overt CKD (eGFR > 60 ml/min, urinary albumin creatinine ratio <30 mg/g), the NGAL/creatinine ratio was 2.6 higher in CI-AKI vs. no CI-AKI (47.8 [IQR 11.8–75.3] vs. 18.6 [IQR 11.7–36.3] μg/mg). No significant differences were obtained for KIM-1 and calprotectin (p>0.05 each). ROC analyses revealed an area under the curve (AUC) of 0.68 (95% CI 0.60–0.81) for NGAL/creatinine. An NGAL/creatinine ratio < 56.4 μg/mg has a negative predictive value of 96.5%. Conclusions The present study is the largest investigation on the use of urinary biomarkers for CI-AKI risk stratification so far. It shows that NGAL provides prognostic information beyond the glomerular biomarkers eGFR and proteinuria.
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Affiliation(s)
- Felix S. Seibert
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
- * E-mail:
| | - Anja Heringhaus
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Nikolaos Pagonas
- Department for Angiology, Centre for Internal Medicine I, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University of Bochum, Herne, Germany
| | - Benjamin Rohn
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Frederic Bauer
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry & Epidemiology, Ruhr-University of Bochum, Herne, Germany
| | - Hans-Joachim Trappe
- Department of Cardiology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Nina Babel
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
| | - Timm H. Westhoff
- Department of Nephrology, University Hospital Marien Hospital Herne, Ruhr-University of Bochum, Herne, Germany
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Liu Y, Chen S, Ye J, Xian Y, Wang X, Xuan J, Tan N, Li Q, Chen J, Ni Z. Random forest for prediction of contrast-induced nephropathy following coronary angiography. Int J Cardiovasc Imaging 2020; 36:983-991. [PMID: 32285318 DOI: 10.1007/s10554-019-01730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 11/05/2019] [Indexed: 11/28/2022]
Abstract
The majority of prediction models for contrast-induced nephropathy (CIN) have moderate performance. Therefore, we aimed to develop a better pre-procedural prediction tool for CIN following contemporary percutaneous coronary intervention (PCI) or coronary angiography (CAG). A total of 3469 patients undergoing PCI/CAG between January 2010 and December 2013 were randomly divided into a training (n = 2428, 70%) and validation data-sets (n = 1041, 30%). Random forest full models were developed using 40 pre-procedural variables, of which 13 variables were selected for a reduced CIN model. CIN developed in 78 (3.21%) and 37 of patients (3.54%) in the training and validation datasets, respectively. In the validation dataset, the full and reduced models demonstrated improved discrimination over classic Mehran, ACEF CIN risk scores (AUC 0.842 and 0.825 over 0.762 and 0.701, respectively, all P < 0.05) and common estimated glomerular filtration rate. Compared to that for the Mehran risk score model, the full and reduced models had significantly improved fit based on the net reclassification improvement (all P < 0.001) and integrated discrimination improvement (P = 0.001, 0.028, respectively). Using the above models, 2462 (66.7%), 661, and 346 patients were categorized into low (< 1%), moderate (1% to 7%), and high (> 7%) risk groups, respectively. Our pre-procedural CIN risk prediction algorithm (http://cincalc.com) demonstrated good discriminative ability and was well calibrated when validated. Two-thirds of the patients were at low CIN risk, probably needing less peri-procedural preventive strategy; however, the discriminative ability of CIN risk requires further external validation. TRIAL REGISTRATION: ClinicalTrials.gov NCT01400295.
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Affiliation(s)
- Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,The George Institute for Global Health, The University of New South Wales, Sydney, Australia.,Department of Cardiology&Dongguan Division of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Dongguan TCM Hospital, Dongguan, China
| | - Jianfeng Ye
- Department of Cardiology&Dongguan Division of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Dongguan TCM Hospital, Dongguan, China
| | - Ying Xian
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Xia Wang
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | | | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qiang Li
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. .,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510100, China.
| | - Zhonghan Ni
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. .,Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, South China University of Technology, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, 510100, China.
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Effect of Different Iodine Concentrations on Patient-Reported Discomfort in Contrast-Enhanced Computed Tomography: A Prospective Comparative Trial. ROFO-FORTSCHR RONTG 2020; 192:945-951. [PMID: 32215899 DOI: 10.1055/a-1132-5544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Reducing contrast media injection speed while maintaining iodine flux is a promising workaround to lower or avoid contrast media-related discomfort during CT examinations. This approach demands contrast media with a higher concentration to guarantee excellent image quality. It remains unclear whether these concentration changes affect the patient's experience. Thus, the aim of this study was to evaluate the influence of different concentrations of intravenous iodinated contrast media on patient discomfort during and after contrast media delivery. MATERIALS AND METHODS Patients were randomized to receive either Iomeprol 400 mg/ml (group A) or 300 mg/ml (group B) during routinely scheduled CT examinations at our department. The iodine delivery rate and injection time were kept constant in both groups. After examination, study subjects completed a digital questionnaire on different CM-related sensation items using digital visual analogue scales. RESULTS 253 consecutive patients were enrolled in a 6-month period. Most of the patients reported heat sensation in both groups (mean VAS: 5.3 mm in group A vs. 5.0 mm in group B, p = 0.5). Taste sensation also did not differ significantly between both groups (2.4 mm vs. 2.0 mm, p = 0.08). Pain sensation was reported to be significantly lower in group B patients (1.3 mm vs. 1.0 mm, p = 0.005), even though pain sensation in general was reported on a very low level. Other injection-related sensations were rarely reported. CONCLUSION Patient-reported discomfort during intravenous injection of high-concentration contrast media (400 mg/ml) was low and only marginally different when compared to the injection of contrast media with a lower concentration. The injection of highly concentrated contrast media showed comparable overall patient acceptance, allowing a reduction of the injection speed and volume during examinations. KEY POINTS · Patient-reported, contrast-related discomfort was very low in this study.. · High-concentration contrast media (HCCM) showed comparable overall patient acceptance.. · HCCM allow a reduction of injection speeds while keeping iodine flux constant.. CITATION FORMAT · Vahldiek JL, Schaafs LA, Niehues BK et al. Effect of Different Iodine Concentrations on Patient-Reported Discomfort in Contrast-Enhanced Computed Tomography: A Prospective Comparative Trial. Fortschr Röntgenstr 2020; 192: 945 - 951.
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Ackerson NOB, Liberatore HK, Plewa MJ, Richardson SD, Ternes TA, Duirk SE. Disinfection byproducts and halogen-specific total organic halogen speciation in chlorinated source waters - The impact of iopamidol and bromide. J Environ Sci (China) 2020; 89:90-101. [PMID: 31892405 DOI: 10.1016/j.jes.2019.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 06/10/2023]
Abstract
This study investigated the speciation of halogen-specific total organic halogen and disinfection byproducts (DBPs) upon chlorination of natural organic matter (NOM) in the presence of iopamidol and bromide (Br-). Experiments were conducted with low bromide source waters with different NOM characteristics from Northeast Ohio, USA and varied spiked levels of bromide (2-30 μmol/L) and iopamidol (1-5 μmol/L). Iopamidol was found to be a direct precursor to trihalomethane (THM) and haloacetic acid formation, and in the presence of Br- favored brominated analogs. The concentration and speciation of DBPs formed were impacted by iopamidol and bromide concentrations, as well as the presence of NOM. As iopamidol increased the concentration of iodinated DBPs (iodo-DBPs) and THMs increased. However, as Br- concentrations increased, the concentrations of non-brominated iodo- and chloro-DBPs decreased while brominated-DBPs increased. Regardless of the concentration of either iopamidol or bromide, bromochloroiodomethane (CHBrClI) was the most predominant iodo-DBP formed except at the lowest bromide concentration studied. At relevant concentrations of iopamidol (1 μmol/L) and bromide (2 μmol/L), significant quantities of highly toxic iodinated and brominated DBPs were formed. However, the rapid oxidation and incorporation of bromide appear to inhibit iodo-DBP formation under conditions relevant to drinking water treatment.
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Affiliation(s)
| | - Hannah K Liberatore
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC 29208, USA
| | - Michael J Plewa
- Department of Crop Sciences and Safe Global Water Institute, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Susan D Richardson
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC 29208, USA
| | - Thomas A Ternes
- Federal Institute of Hydrology (BfG), D-56068 Koblenz, Germany
| | - Stephen E Duirk
- Department of Civil Engineering, University of Akron, Akron, OH 44325, USA.
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Nijssen EC, Nelemans PJ, Rennenberg RJ, van der Molen AJ, van Ommen GV, Wildberger JE. Impact on clinical practice of updated guidelines on iodinated contrast material: CINART. Eur Radiol 2020; 30:4005-4013. [PMID: 32107605 PMCID: PMC7305084 DOI: 10.1007/s00330-020-06719-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022]
Abstract
Objective Guidelines on safe use of iodinated contrast material recommend intravenous prophylactic hydration to prevent post-contrast adverse (renal) effects. Recently, guidelines have been updated and standard prophylaxis is no longer recommended for the majority of patients. The current study aims to evaluate the consequences for clinical practice of the updated guidelines in terms of complications, hospitalisations, and costs. Methods The Contrast-Induced Nephropathy After Reduction of the prophylaxis Threshold (CINART) project is a retrospective observational study. All elective procedures with intravascular iodinated contrast administration at Maastricht University Medical Centre (UMC+) in patients aged > 18 years, formerly eligible for prophylaxis (eGFR 30–44 ml/min/1.73 m2 or eGFR 45–59 ml/min/1.73 m2 in combination with diabetes or > 1 predefined risk factor), and currently eligible for prophylaxis (eGFR < 30 ml/min/1.73 m2) were included. Data were used to calculate relative reductions in complications, hospitalisations, and costs associated with standard prophylactic intravenous hydration. CINART is registered with Clinicaltrials.gov: NCT03227835. Results Between July 1, 2017, and July 1, 2018, 1992 elective procedures with intravascular iodinated contrast in patients formerly and currently eligible for prophylaxis were identified: 1808 in patients formerly eligible for prophylaxis and 184 in patients currently eligible for prophylaxis. At Maastricht UMC+, guideline updates led to large relative reductions in numbers of complications of prophylaxis (e.g. symptomatic heart failure; − 89%), extra hospitalisations (− 93%), and costs (− 91%). Conclusion Guideline updates have had a demonstrable impact on daily clinical practice benefiting patient, hospital, and health care budgets. Clinical practice varies between institutions and countries; therefore, a local estimation model is provided with which local impact on costs, hospitalisations, and complications can be calculated. Key Points • Clinical practice guidelines recommend prophylactic intravenous hydration to prevent post-contrast adverse outcomes such as contrast-induced acute kidney injury. • Clinical practice guidelines have recently been updated, and standard prophylaxis is no longer recommended for the majority of patients. • The guideline updates have a large impact on daily clinical practice: relative reductions at Maastricht UMC+ were − 89% prophylaxis complications, − 93% hospitalisations, and − 91% costs, and similar reductions are expected for Dutch and adherent European medical centres. Electronic supplementary material The online version of this article (10.1007/s00330-020-06719-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E C Nijssen
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - P J Nelemans
- Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - R J Rennenberg
- Department of Internal Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - A J van der Molen
- Department of Radiology, Leiden University Medical Centre, Postal zone C-2S, 2333 ZA, Leiden, The Netherlands
| | - G V van Ommen
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - J E Wildberger
- Department of Radiology & Nuclear Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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49
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Wang Z, Wang X, Yuan R, Xiao D. Resolving the kinetic and intrinsic constraints of heat-activated peroxydisulfate oxidation of iopromide in aqueous solution. JOURNAL OF HAZARDOUS MATERIALS 2020; 384:121281. [PMID: 31585288 DOI: 10.1016/j.jhazmat.2019.121281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
Iopromide (IOP) has been identified as one of the most persistent pharmaceuticals in wastewater treatment processes, however, kinetic and intrinsic factors constraining its fast removal in advanced oxidation processes (AOPs) are yet to be resolved. Here oxidation of IOP by heat-activated peroxydisulfate (PDS) was investigated both experimentally and theoretically. Rates of IOP degradation were enhanced by elevating solution temperature and acidity. An apparent kinetic rate equation was developed, based on the pseudo-first-order reaction model and assumption of steady state of SO4-. The common water constituents showed inhibitory effects on IOP decomposition to various extent. An insufficient supply of SO4- was considered as the major kinetic constraint. Eight byproducts were identified and most of which had intact triiodinated benzene ring. O-demethylation, oxidation of amino moiety and oxidation/elimination of alcohol groups are proposed as the primary degradation pathways, in accordance with the incomplete mineralization and non-detectable release of inorganic iodine. Quantum chemical calculations predict that oxidation of alkyl chains of IOP preferentially occurs and IOP byproducts with shorter side chains and intact triiodinated ring are more reactive than IOP. By virtue of the identified kinetic and intrinsic constraints, strategies to maximize degradation efficiency of IOP are proposed.
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Affiliation(s)
- Zhaohui Wang
- Shanghai Key Laboratory of Urbanization and Ecological Restoration, School of Ecological and Environmental Sciences, East China Normal University, Shanghai 200241, China; College of Environmental Science and Engineering, Donghua University, Shanghai, 201620, China; Institute of Eco-Chongming (IEC), Shanghai 200062, China.
| | - Xiaoxiao Wang
- College of Environmental Science and Engineering, Donghua University, Shanghai, 201620, China
| | - Ruixia Yuan
- College of Chemistry and Chemical Engineering, Northeast Petroleum University, Daqing, 163318, China
| | - Dongxue Xiao
- Chinese Academy of Fishery Sciences, East China Sea Fisheries Research Institute, Shanghai 200090, China
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50
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Yin W, Zhou G, Zhou L, Liu M, Xie Y, Wang J, Zuo S, Liu K, Hu C, Chen L, Yang H, Zuo X. Validation of pre-operative risk scores of contrast-induced acute kidney injury in a Chinese cohort. BMC Nephrol 2020; 21:45. [PMID: 32041557 PMCID: PMC7011449 DOI: 10.1186/s12882-020-1700-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/20/2020] [Indexed: 01/09/2023] Open
Abstract
Background Pre-operative risk scores are more valuable than post-procedure risk scores because of lacking effective treatment for contrast-induced acute kidney injury (CI-AKI). A number of pre-operative risk scores have been developed, but due to lack of effective external validation, most of them are also difficult to apply accurately in clinical practice. It is necessary to review and validate the published pre-operative risk scores for CI-AKI. Materials and methods We systematically searched PubMed and EMBASE databases for studies of CI-AKI pre-operative risk scores and assessed their calibration and discriminatory in a cohort of 2669 patients undergoing coronary angiography or percutaneous coronary intervention (PCI) from September 2007 to July 2017. The definitions of CI-AKI may affect the validation results, so three definition were included in this study, CI-AKI broad1 was defined as an increase in serum creatinine (Scr) of 44.2 μmol/L or 25%; CI-AKI broad2, an increase in Scr of 44.2 μmol/L or 50%; and CI-AKI-narrow, an increase in Scr of 44.2 μmol/L. The calibration of the model was assessed with the Hosmer-Lemeshow test and the discriminatory capacity was identified by C-statistic. Results Of the 8 pre-operative risk scores for CI-AKI identified, 7 were single-center study and only 1 was based on multi-center study. In addition, 7 of the scores were just validated internally and only Chen score was externally validated. In the validation cohort of 2669 patients, the incidence of CI-AKI ranged from 3.0%(Liu) to 16.4%(Chen) for these scores. Furthermore, the incidence of CI-AKI was 6.59% (178) for CI-AKI broad1, 1.44% (39) for CI-AKI broad2, and 0.67% (18) for CI-AKI-narrow. For CI-AKI broads, C-statistics varied from 0.44 to 0.57. For CI-AKI-narrow, the Maioli score had the best discrimination and calibration, what’s more, the C-statistics of Maioli, Chen, Liu and Ghani was ≥0.7. Conclusion Most pre-operative risk scores were established based on single-center studies and most of them lacked external validation. For CI-AKI broads, the prediction accuracy of all risk scores was low. The Maioli score had the best discrimination and calibration, when using the CI-AKI-narrow definition.
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Affiliation(s)
- Wenjun Yin
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ge Zhou
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lingyun Zhou
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Mancang Liu
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yueliang Xie
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianglin Wang
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Shanru Zuo
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Kun Liu
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Can Hu
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Linhua Chen
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huiqin Yang
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaocong Zuo
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China. .,Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China.
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