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Xiang H, Zhao Y, Ma S, Li Q, Kashani KB, Peng Z, Li J, Hu B. Dose-related effects of norepinephrine on early-stage endotoxemic shock in a swine model. JOURNAL OF INTENSIVE MEDICINE 2023; 3:335-344. [PMID: 38028636 PMCID: PMC10658043 DOI: 10.1016/j.jointm.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/20/2023] [Accepted: 06/20/2023] [Indexed: 12/01/2023]
Abstract
Background The benefits of early use of norepinephrine in endotoxemic shock remain unknown. We aimed to elucidate the effects of different doses of norepinephrine in early-stage endotoxemic shock using a clinically relevant large animal model. Methods Vasodilatory shock was induced by endotoxin bolus in 30 Bama suckling pigs. Treatment included fluid resuscitation and administration of different doses of norepinephrine, to induce return to baseline mean arterial pressure (MAP). Fluid management, hemodynamic, microcirculation, inflammation, and organ function variables were monitored. All animals were supported for 6 h after endotoxemic shock. Results Infused fluid volume decreased with increasing norepinephrine dose. Return to baseline MAP was achieved more frequently with doses of 0.8 µg/kg/min and 1.6 µg/kg/min (P <0.01). At the end of the shock resuscitation period, cardiac index was higher in pigs treated with 0.8 µg/kg/min norepinephrine (P <0.01), while systemic vascular resistance was higher in those receiving 0.4 µg/kg/min (P <0.01). Extravascular lung water level and degree of organ edema were higher in animals administered no or 0.2 µg/kg/min norepinephrine (P <0.01), while the percentage of perfused small vessel density (PSVD) was higher in those receiving 0.8 µg/kg/min (P <0.05) and serum lactate was higher in the groups administered no and 1.6 µg/kg/min norepinephrine (P <0.01). Conclusions The impact of norepinephrine on the macro- and micro-circulation in early-stage endotoxemic shock is dose-dependent, with very low and very high doses resulting in detrimental effects. Only an appropriate norepinephrine dose was associated with improved tissue perfusion and organ function.
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Affiliation(s)
- Hui Xiang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei, China
| | - Yuqian Zhao
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei, China
| | - Siqing Ma
- Department of Critical Care Medicine, Qinghai Provincial People's Hospital, Xining 810007, Qinghai, China
| | - Qi Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei, China
| | - Kianoush B. Kashani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei, China
| | - Jianguo Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Wuhan 430071, Hubei, China
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Helmers R, Straat NF, Navran A, Nai Chung Tong TAP, Teguh DN, van Hulst RA, de Lange J, Milstein DMJ. Patient-Side Appraisal of Late Radiation-Induced Oral Microvascular Changes. Int J Radiat Oncol Biol Phys 2018; 102:1299-1307. [PMID: 29506885 DOI: 10.1016/j.ijrobp.2018.01.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/09/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the clinical feasibility of examining and measuring late irradiation changes in the oral microcirculation of head and neck (HN) cancer patients using the novel CytoCam video microscope system. METHODS AND MATERIALS In 30 HN cancer patients and 30 age-matched controls, bilateral video images were recorded noninvasively of the oral microcirculation of the buccal mucosa and mandibular gingiva. Tissue perfusion parameters, such as functional capillary density (FCD), buccal blood vessel diameter, and microcirculatory flow index, were analyzed. RESULTS No difference was observed for mean buccal mucosa FCD in irradiated versus healthy tissue, whereas a lower mean gingival FCD in irradiated versus healthy tissue was observed (34 ± 17 capillaries per millimeter squared [cpll/mm2] vs 68 ± 19 cpll/mm2; P < .001). A significant difference in mean buccal blood vessel diameter of 16 ± 3 μm was measured, compared with 14 ± 1 μm in control buccal mucosa (P < .001). No significant difference in microcirculatory flow index was observed between the 2 groups. CONCLUSIONS Quantifying oral microcirculatory injury associated with late irradiation effects using the CytoCam was feasible in HN cancer patients. Results indicate that marked differences in tissue-specific microcirculatory measurements of angioarchitecture, diminished capillary density, and extensively dilated blood vessel diameters are associated with late irradiation effects in HN cancer patients.
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Affiliation(s)
- Renée Helmers
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - Nina F Straat
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Tim A P Nai Chung Tong
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - David N Teguh
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Robert A van Hulst
- Department of Hyperbaric Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Dan M J Milstein
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Maslennikova AV, Sirotkina MA, Moiseev AA, Finagina ES, Ksenofontov SY, Gelikonov GV, Matveev LA, Kiseleva EB, Zaitsev VY, Zagaynova EV, Feldchtein FI, Gladkova ND, Vitkin A. In-vivo longitudinal imaging of microvascular changes in irradiated oral mucosa of radiotherapy cancer patients using optical coherence tomography. Sci Rep 2017; 7:16505. [PMID: 29184130 PMCID: PMC5705675 DOI: 10.1038/s41598-017-16823-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/17/2017] [Indexed: 01/21/2023] Open
Abstract
Mucositis is the limiting toxicity of radio(chemo)therapy of head and neck cancer. Diagnostics, prophylaxis and correction of this condition demand new accurate and objective approaches. Here we report on an in vivo longitudinal monitoring of the oral mucosa dynamics in 25 patients during the course of radiotherapy of oropharyngeal and nasopharyngeal cancer using multifunctional optical coherence tomography (OCT). A spectral domain OCT system with a specially-designed oral imaging probe was used. Microvasculature visualization was based on temporal speckle variations of the full complex signal evaluated by high-pass filtering of 3D data along the slow scan axis. Angiographic image quantification demonstrated an increase of the vascular density and total length of capillary-like-vessels before visual signs or clinical symptoms of mucositis occur. Especially significant microvascular changes compared to their initial levels occurred when grade two and three mucositis developed. Further, microvascular reaction was seen to be dose-level dependent. OCT monitoring in radiotherapy offers a non-invasive, convenient, label-free quantifiable structural and functional volumetric imaging method suitable for longitudinal human patient studies, furnishing fundamental radiobiological insights and potentially providing useful feedback data to enable adaptive radiotherapy (ART).
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Affiliation(s)
- A V Maslennikova
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
- Lobachevsky University, Gagarin Ave 23, 603950, Nizhny Novgorod, Russia
| | - M A Sirotkina
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia.
| | - A A Moiseev
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
- Institute of Applied Physics Russian Academy of Sciences, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - E S Finagina
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - S Y Ksenofontov
- Institute of Applied Physics Russian Academy of Sciences, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - G V Gelikonov
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
- Institute of Applied Physics Russian Academy of Sciences, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - L A Matveev
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
- Institute of Applied Physics Russian Academy of Sciences, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - E B Kiseleva
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - V Y Zaitsev
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
- Institute of Applied Physics Russian Academy of Sciences, Ulyanova Street 46, 603950, Nizhny Novgorod, Russia
| | - E V Zagaynova
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - F I Feldchtein
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - N D Gladkova
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
| | - A Vitkin
- Nizhny Novgorod State Medical Academy, Minina Square 10/1, 603005, Nizhny Novgorod, Russia
- University of Toronto and University Health Network, 610 University Ave., Toronto, Ontario, M5G 2M9, Canada
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Radnay ZB, Udvardy M, Papp M, Hársfalvi J, Rejto L, Pál I, Illés Á, Kiss A. Evaluation of Mannose-Binding Lectin is a Useful Approach to Predict the Risk of Infectious Complications Following Autologous Hematopoietic Stem Cell Transplantation. Transplant Proc 2017; 48:3397-3405. [PMID: 27931588 DOI: 10.1016/j.transproceed.2016.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/27/2016] [Accepted: 08/22/2016] [Indexed: 01/03/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) associated immunocompromised state carries high risk of infectious complications. Mannose-binding lectin (MBL) is an acute phase protein involved in innate immune response. Serum MBL level is genetically determined and quite stable. According to literature, significant association was shown between low MBL concentrations and serious infections. The association between serum MBL level and frequency and severity of infections was studied in 186 patients following autologous HSCT. Double-monoclonal antibody sandwich enzyme-linked immunosorbent assay was used to determine MBL antigen level in sera. MBL levels were measured around 100 days following transplantation, in a period without active infection. Twenty-one patients (11%) were MBL deficient. The median time of first infection and number of infections during the first year post-transplantation were not significantly different between patients with MBL deficiency and those without MBL deficiency. The occurrence and number of infections after HSCT correlated with the MBL/C-reactive protein ratio. The number of severe infections was not higher among those with MBL deficiency. The occurrence of infections after the pre-engraftment period during the first year post-transplantation was significantly different in patient groups separated by MBL cut-off level. The MBL/C-reactive protein ratio might be a useful marker of infectious complications. MBL measurement may be helpful in antibiotic treatment. In case of MBL deficiency, earlier and more intensive treatment may be indicated.
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Affiliation(s)
- Z B Radnay
- Department of Hematology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - M Udvardy
- Department of Hematology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - M Papp
- Department of Gastroenterology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - J Hársfalvi
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary; Clinical Research Center, Faculty of Medicine, University of Debrecen, Hungary
| | - L Rejto
- Department of Hematology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - I Pál
- Department of Hematology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Á Illés
- Department of Hematology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Kiss
- Department of Hematology, Institute for Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Scardina GA, Cacioppo A, Messina P. Changes of oral microcirculation in chemotherapy patients: A possible correlation with mucositis? Clin Anat 2013; 27:417-22. [DOI: 10.1002/ca.22300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/26/2013] [Accepted: 06/26/2013] [Indexed: 12/29/2022]
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Tytgat SHAJ, van der Zee DC, Ince C, Milstein DMJ. Carbon dioxide gas pneumoperitoneum induces minimal microcirculatory changes in neonates during laparoscopic pyloromyotomy. Surg Endosc 2013; 27:3465-73. [DOI: 10.1007/s00464-013-2927-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/22/2013] [Indexed: 10/27/2022]
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Ince C, van Kuijen AM, Milstein DMJ, Yürük K, Folkow LP, Fokkens WJ, Blix AS. Why Rudolph's nose is red: observational study. BMJ 2012; 345:e8311. [PMID: 23247980 PMCID: PMC3524369 DOI: 10.1136/bmj.e8311] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterise the functional morphology of the nasal microcirculation in humans in comparison with reindeer as a means of testing the hypothesis that the luminous red nose of Rudolph, one of the most well known reindeer pulling Santa Claus's sleigh, is due to the presence of a highly dense and rich nasal microcirculation. DESIGN Observational study. SETTING Tromsø, Norway (near the North Pole), and Amsterdam, the Netherlands. PARTICIPANTS Five healthy human volunteers, two adult reindeer, and a patient with grade 3 nasal polyposis. MAIN OUTCOME MEASURES Architecture of the microvasculature of the nasal septal mucosa and head of the inferior turbinates, kinetics of red blood cells, and real time reactivity of the microcirculation to topical medicines. RESULTS Similarities between human and reindeer nasal microcirculation were uncovered. Hairpin-like capillaries in the reindeers' nasal septal mucosa were rich in red blood cells, with a perfused vessel density of 20 (SD 0.7) mm/mm(2). Scattered crypt or gland-like structures surrounded by capillaries containing flowing red blood cells were found in human and reindeer noses. In a healthy volunteer, nasal microvascular reactivity was demonstrated by the application of a local anaesthetic with vasoconstrictor activity, which resulted in direct cessation of capillary blood flow. Abnormal microvasculature was observed in the patient with nasal polyposis. CONCLUSIONS The nasal microcirculation of reindeer is richly vascularised, with a vascular density 25% higher than that in humans. These results highlight the intrinsic physiological properties of Rudolph's legendary luminous red nose, which help to protect it from freezing during sleigh rides and to regulate the temperature of the reindeer's brain, factors essential for flying reindeer pulling Santa Claus's sleigh under extreme temperatures.
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Affiliation(s)
- Can Ince
- Department of Intensive Care Medicine, Erasmus Medical Center, Erasmus University Rotterdam, 's-Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, Netherlands.
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Abstract
PURPOSE OF REVIEW Mucositis has long been viewed as an unavoidable consequence of high-dose chemotherapy and/or radiation. Management has been directed to supportive care including oral pain control, nutritional support, infection treatment and control of diarrhea. Whereas these interventions have been valuable for clinical management, they have not been collectively directed to molecularly targeted prevention and treatment. This review addresses recent advances regarding mucosal injury in cancer patients, with emphasis on symptom clusters, genetically based tissue susceptibility and risk prediction, imaging technology, and computational biology. RECENT FINDINGS Modeling of symptom clusters in cancer patients continues to mature. Although integration of mucositis into the paradigm is at an early stage, recent studies suggest that important molecular and clinical insights will emerge in this regard. Initial studies of genetic-based tissue risk are also providing a research basis that may lead to clinical risk prediction models. These advances are in part being engineered via new imaging and computational biology technologies, drawing upon literature in nonmucositis systems. Just as the past decade has been hallmarked by linkage of pathobiology with clinical expression of mucosal toxicity, the next decade promises to identify new molecular interactions and risk prediction models based on novel application of the analytic technologies. SUMMARY Recent research has culminated in convergence of molecular pathobiology with models of symptom clusters, genetic-based risk, and imaging and computational biology. The field is poised to further delineate this paradigm, with the goal of development of molecularly targeted drugs and devices for mucositis management.
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Abstract
Mucosal damage is one of the most common adverse effects of radiotherapy and of cytotoxic therapy for cancer. With prevalence between 10% and 100%, depending of the cytotoxic regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. In this paper we address oral mucositis and discuss its pathobiology, risk factors, impact and management in view of the most recent evidence. Despite of clear progress and the development of clinical guidelines, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.
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Affiliation(s)
- Judith E Raber-Durlacher
- Department of Periodontology, Academic Centre of Dentistry, Louwesweg 1, 1066 EA, Amsterdam, The Netherlands.
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