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Rothka AJ, Jonik S, Nelsen J, Patel S, Cherin N. A case of SIADH following uncomplicated mild traumatic brain injury: Did cognitive bias delay treatment? Clin Case Rep 2024; 12:e8874. [PMID: 38725933 PMCID: PMC11079531 DOI: 10.1002/ccr3.8874] [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: 03/14/2024] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
To optimize clinical care, it is imperative for providers to recognize their own inherent cognitive biases and the impact that has on their clinical decision making, thereby minimizing complications such as prolonged hospitalization, unnecessary healthcare spending, and impaired patient satisfaction and functional outcomes.
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Affiliation(s)
| | | | - Jacob Nelsen
- Penn State College of MedicineHersheyPennsylvaniaUSA
| | - Shivani Patel
- Penn State Health Department of Physical Medicine and RehabilitationPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Neyha Cherin
- Penn State Health Department of Physical Medicine and RehabilitationPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
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2
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Chromiak AE, Finstad J, Cooper E. Suspected cerebral salt wasting syndrome secondary to traumatic brain injury in a dog. J Vet Emerg Crit Care (San Antonio) 2024; 34:285-290. [PMID: 38809227 DOI: 10.1111/vec.13375] [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: 06/12/2023] [Revised: 01/14/2024] [Accepted: 03/21/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To describe a dog with suspected cerebral salt wasting syndrome (CSWS) secondary to traumatic brain injury (TBI). CASE SUMMARY A 2-month-old intact male Chihuahua-American Pitbull Terrier mix weighing 1.94 kg presented to a veterinary teaching emergency room after suffering bite wound-penetrating trauma to the head. Treatment was initiated with hyperosmotic agents, fluid resuscitation, and analgesia. The dog's neurologic dysfunction warranted hospitalization and continuous monitoring. Within 24 hours, the dog developed hyponatremia (133 mmol/L compared to 143 mmol/L on presentation [reference interval 142-149 mmol/L]). As the dog had concurrent tachycardia, increase in urine sodium concentration, polyuria, and weight loss, a diagnosis of cerebral salt wasting was suspected. A 2% hypertonic saline constant rate infusion was administered for volume replacement, and the patient showed improvement in clinical signs and blood sodium concentration. The dog was discharged on Day 5. Recheck examination showed significant neurologic improvement with sodium just below the low end of the reference range (141 mmol/L [reference interval 142-149 mmol/L]). NEW OR UNIQUE INFORMATION PROVIDED This is the first description of suspected CSWS in veterinary medicine. Hyponatremia is a common finding in critically ill neurologic people, including those with TBI, and is typically associated with either syndrome of inappropriate antidiuretic hormone or CSWS. As treatment recommendations for syndrome of inappropriate antidiuretic hormone and CSWS are diametrically opposed, identifying the presence of hyponatremia and distinguishing between these 2 clinical entities is critical for improving patient care for those with TBI. This case highlights the characteristics and clinical progression regarding the diagnosis and management of suspected CSWS.
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Affiliation(s)
- Amanda E Chromiak
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Joanna Finstad
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Edward Cooper
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
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Lopes AC, Lourenço O, Morgado S, Gaspar A, Freire I, Eusébio I, Ribeiro J, Silva M, Mendes M, Fonseca O, Duarte R, Morgado M. Acute Kidney Injury and Electrolyte Imbalances Caused by Dapagliflozin Short-Term Use. Pharmaceuticals (Basel) 2024; 17:420. [PMID: 38675382 PMCID: PMC11053518 DOI: 10.3390/ph17040420] [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: 02/19/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Dapagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i), has shown demonstrated benefits for renal and cardiovascular outcomes in large clinical trials. However, short-term concerns regarding its impact on renal function and electrolyte balance exist. This study aimed to evaluate the short-term effects of dapagliflozin on renal function and electrolyte balance in patients newly prescribed the medication. A retrospective analysis of 246 patients who initiated dapagliflozin therapy was conducted. Serum creatinine, sodium, and potassium levels were measured at baseline (before dapagliflozin) and 5-8 days after initiation (endpoint). A Wilcoxon signed-rank test, Pearson's chi-square test, and Fischer's exact test were used for the data analysis. Glycemia and sodium levels were significantly higher at the baseline compared to the endpoint (p < 0.001). Conversely, creatinine and potassium levels were significantly higher at the endpoint than at the baseline (p < 0.001). The prevalence of hyponatremia and hyperkalemia were increased at the endpoint (17.5% vs. 10.2% and 16.7% vs. 8.9%, respectively). Although not statistically significant, a trend towards increased hyponatremia with the co-administration of furosemide was observed (p = 0.089). No significant association was found between potassium-sparing medications (p > 0.05) and hyperkalemia, except for angiotensin receptor blockers (p = 0.017). The combination of dapagliflozin and furosemide significantly increased the risk of acute kidney injury (AKI) at the endpoint (p = 0.006). Age, gender, and chronic kidney disease status did not significantly influence the occurrence of AKI, hyponatremia, or hyperkalemia (p > 0.05). These findings emphasize the importance of the close monitoring of renal function and electrolyte balance, particularly in the early stages of dapagliflozin therapy, especially in patients receiving diuretics or renin-angiotensin-aldosterone system inhibitors.
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Affiliation(s)
- António Cabral Lopes
- Pharmaceutical Services of Local Health Unit of Guarda (ULS da Guarda), 6300-035 Guarda, Portugal
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
| | - Olga Lourenço
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
| | - Sandra Morgado
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Andreia Gaspar
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Idalina Freire
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Inês Eusébio
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - João Ribeiro
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Mafalda Silva
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Marta Mendes
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Olímpia Fonseca
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Rute Duarte
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
| | - Manuel Morgado
- FCS-UBI, Faculty of Health Sciences, University of Beira Interior, 6200-506 Covilhã, Portugal; (O.L.); (S.M.); (I.F.); (J.R.); (O.F.); (M.M.)
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- Pharmaceutical Services of Local Health Unit of Cova da Beira (ULS Cova da Beira), 6200-251 Covilhã, Portugal; (A.G.); (I.E.); (M.S.); (M.M.); (R.D.)
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Edwards MGP, Andersen JR, Curtis DJ, Riberholt CG, Poulsen I. Diet-induced ketosis in adult patients with subacute acquired brain injury: a feasibility study. Front Med (Lausanne) 2024; 10:1305888. [PMID: 38571572 PMCID: PMC10990248 DOI: 10.3389/fmed.2023.1305888] [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: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 04/05/2024] Open
Abstract
Background Research in animal models on cerebral metabolism after brain injury highlights the potential benefits of ketosis in reducing secondary brain injury, but studies in humans are lacking. Aim This study aimed to examine if a 6-week ketogenic diet intervention with added medium-chain triglycerides (MCT) was feasible in adult patients with acquired brain injury in the subacute phase, whether ketosis could be achieved and maintained, and to what extent serious adverse reactions, adverse reactions, serious adverse events, and adverse events occured. Methods Patients ≥18 years of age diagnosed with subacute acquired brain injury and an expectation of hospitalisation ≥6 weeks were included in the intervention group. Patients not included in the intervention group were included in a standard care reference group. The intervention consisted of a ketogenic diet supplemented with MCT to obtain a plasma concentration of β-hydroxybutyrate (BHB) ≥0.5 mmol/L. Patients who were enterally fed were given KetoCal® 2.5:1 LQ MCT Multi Fiber (Nutricia A/S, Allerød, Denmark), supplemented with Liquigen® (Nutricia A/S, Allerød, Denmark). Patients consuming oral nutrition were given KetoCal® 2.5:1 LQ MCT Multi Fiber supplemented with Liquigen®, in addition to ketogenic meals. Results During a 13-week inclusion period, 12 of 13 eligible patients (92% [95% CI: 67% to 99%]) were included in the intervention group, and 17 of 18 excluded patients (94% [95% CI: 74% to 99%]) were included in the reference group. Eight patients (67%) completed the 6-week intervention. It took a median of 1 day to achieve ketosis from starting a 100% MCT ketogenic diet, and it was maintained for 97% of the intervention period after ketosis was obtained. There were no serious adverse reactions to the MCT ketogenic diet, and patients experienced adverse reactions not considered serious in 9.5% of days with the intervention. The MCT ketogenic diet was accepted by patients on all intervention days, and in the two patients transitioning from enteral feeding to oral intake, there were no complications related to transitioning. Conclusion Intervention with MCT ketogenic diet is feasible and tolerated for 6 weeks in hospitalised adult patients with subacute acquired brain injury. Randomised controlled trials are needed to assess the benefits and harms of the MCT ketogenic diet and the effect on patients' recovery.Clinical trial registration: ClinicalTrials.gov, identifier [NCT04308577].
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Affiliation(s)
- Maria G. P. Edwards
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Jens R. Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Derek J. Curtis
- Department of Brain and Spinal Cord Injury, Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Christian G. Riberholt
- Department of Brain and Spinal Cord Injury, Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Brain and Spinal Cord Injury, Neuroscience Centre, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
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Innes-Gold SN, Jacobson DR, Pincus PA, Stevens MJ, Saleh OA. Flexible, charged biopolymers in monovalent and mixed-valence salt: Regimes of anomalous electrostatic stiffening and of salt insensitivity. Phys Rev E 2021; 104:014504. [PMID: 34412211 DOI: 10.1103/physreve.104.014504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/21/2021] [Indexed: 11/07/2022]
Abstract
The conformations of biological polyelectrolytes (PEs), such as polysaccharides, proteins, and nucleic acids, affect how they behave and interact with other biomolecules. Relative to neutral polymers, PEs in solution are more locally rigid due to intrachain electrostatic repulsion, the magnitude of which depends on the concentration of added salt. This is typically quantified using the Odijk-Skolnick-Fixman (OSF) electrostatic-stiffening model, in which salt-dependent Debye-Hückel (DH) screening modulates intrachain repulsion. However, the applicability of this approach to flexible PEs has long been questioned. To investigate this, we use high-precision single-molecule elasticity measurements to infer the scaling with salt of the local stiffness of three flexible biopolymers (hyaluronic acid, single-stranded RNA, and single-stranded DNA) in both monovalent and mixed-valence salt solutions. In monovalent salt, we collapse the data across all three polymers by accounting for charge spacing, and find a common power-law scaling of the electrostatic persistence length with ionic strength with an exponent of 0.66±0.02. This result rules out simple OSF pictures of electrostatic stiffening. It is roughly compatible with a modified OSF picture developed by Netz and Orland; alternatively, we posit the exponent can be explained if the relevant electrostatic screening length is the interion spacing rather than the DH length. In mixed salt solutions, we find a regime where adding monovalent salt, in the presence of multivalent salt, does not affect PE stiffness. Using coarse-grained simulations, and a three-state model of condensed, chain-proximate, and bulk ions, we attribute this regime to a "jacket" of ions surrounding the PE that regulates the chain's effective charge density as ionic strength varies. The size of this jacket in simulations is again consistent with a screening length controlled by interion spacing rather than the DH length. Taken together, our results describe a unified picture of the electrostatic stiffness of polyelectrolytes in the mixed-valence salt conditions of direct relevance to cellular and intercellular biological systems.
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Affiliation(s)
- Sarah N Innes-Gold
- Materials Department, University of California, Santa Barbara, California 93106, USA
| | - David R Jacobson
- Physics Department, University of California, Santa Barbara, California 93106, USA
| | - Philip A Pincus
- Materials Department and Physics Department, University of California, Santa Barbara, California 93106, USA
| | - Mark J Stevens
- Center for Integrated Nanotechnologies, Sandia National Laboratories, Albuquerque, New Mexico 87185, USA
| | - Omar A Saleh
- Materials Department and Biomolecular Science and Engineering Program, University of California, Santa Barbara, California 93106, USA
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Kwiecien JM, Dąbrowski W, Yaron JR, Zhang L, Delaney KH, Lucas AR. The Role of Astrogliosis in Formation of the Syrinx in Spinal Cord Injury. Curr Neuropharmacol 2021; 19:294-303. [PMID: 32691715 PMCID: PMC8033977 DOI: 10.2174/1570159x18666200720225222] [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: 05/11/2020] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022] Open
Abstract
A massive localized trauma to the spinal cord results in complex pathologic events driven by necrosis and vascular damage which in turn leads to hemorrhage and edema. Severe, destructive and very protracted inflammatory response is characterized by infiltration by phagocytic macrophages of a site of injury which is converted into a cavity of injury (COI) surrounded by astroglial reaction mounted by the spinal cord. The tissue response to the spinal cord injury (SCI) has been poorly understood but the final outcome appears to be a mature syrinx filled with the cerebrospinal fluid with related neural tissue loss and permanent neurologic deficits. This paper reviews known pathologic mechanisms involved in the formation of the COI after SCI and discusses the integrative role of reactive astrogliosis in mechanisms involved in the removal of edema after the injury. A large proportion of edema fluid originating from the trauma and then from vasogenic edema related to persistent severe inflammation, may be moved into the COI in an active process involving astrogliosis and specifically over-expressed aquaporins.
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Affiliation(s)
- Jacek M. Kwiecien
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Wojciech Dąbrowski
- Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, ul. Jaczewskiego 8, Lublin 20-090 Poland
| | - Jordan R Yaron
- Center for Personalized Diagnostics and Center for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, U.S.A
| | - Liqiang Zhang
- Center for Personalized Diagnostics and Center for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, U.S.A
| | - Kathleen H. Delaney
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alexandra R. Lucas
- Center for Personalized Diagnostics and Center for Immunotherapy, Vaccines and Virotherapy, Biodesign Institute, Arizona State University, Tempe, AZ, U.S.A
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Kwiecien JM. The Pathogenesis of Neurotrauma Indicates Targets for Neuroprotective Therapies. Curr Neuropharmacol 2021; 19:1191-1201. [PMID: 33550977 PMCID: PMC8719295 DOI: 10.2174/1570159x19666210125153308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/06/2020] [Accepted: 01/24/2021] [Indexed: 11/22/2022] Open
Abstract
The spinal cord injury (SCI) initiates an extraordinarily protracted disease with 3 phases; acute, inflammatory, and resolution that are restricted to the cavity of injury (COI) or arachnoiditis by a unique CNS reaction against the severity of destructive inflammation. While the severity of inflammation involving the white matter is fueled by a potently immunogenic activity of damaged myelin, its sequestration in the COI and its continuity with the cerebrospinal fluid of the subdural space allow anti-inflammatory therapeutics infused subdurally to inhibit phagocytic macrophage infiltration and thus provide neuroprotection. The role of astrogliosis in containing and ultimately in eliminating severe destructive inflammation post-trauma appears obvious but is not yet sufficiently understood to use in therapeutic neuroprotective and neuroregenerative strategies. An apparent antiinflammatory activity of reactive astrocytes is paralleled by their active role in removing excess edema fluid in blood-brain barrier damaged by inflammation. Recently elucidated pathogenesis of neurotrauma, including SCI, traumatic brain injury (TBI), and stroke, calls for the following principal therapeutic steps in its treatment leading to the recovery of neurologic function: (1) inhibition and elimination of destructive inflammation from the COI with accompanying reduction of vasogenic edema, (2) insertion into the COI of a functional bridge supporting the crossing of regenerating axons, (3) enabling regeneration of axons to their original synaptic targets by temporary safe removal of myelin in targeted areas of white matter, (4) in vivo, systematic monitoring of the consecutive therapeutic steps. The focus of this paper is on therapeutic step 1.
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Affiliation(s)
- Jacek M. Kwiecien
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Room HSC 1U22D, 1280 Main Street West, Hamilton, ON, L4S 4K1, Canada
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Fereja TH, Wang C, Liu F, Guan Y, Xu G. A high-efficiency cathodic sodium nitroprusside/luminol/H 2O 2 electrochemiluminescence system in neutral media for the detection of sodium nitroprusside, glucose, and glucose oxidase. Analyst 2020; 145:6649-6655. [PMID: 33043929 DOI: 10.1039/d0an01178a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sodium nitroprusside (SNP) is an anti-hypertension drug used in vascular surgery, chronic cardiovascular disease, and in the management of acute myocardial infarction by the spontaneous release of nitric oxide. Herein, for the first time, we extend its application to electrochemiluminescence (ECL). The NO generated from the electrochemical reduction of SNP reacts with H2O2 to generate reactive oxygen species, which subsequently reacts with luminol to produce intense ECL. The ECL signal of the new SNP/H2O2/luminol system under neutral conditions (pH 7.4) is almost equivalent to the classic luminol/H2O2 system at pH 10, making this system highly attractive for bioanalysis that directly or indirectly liberates H2O2 under neutral conditions. At the optimum experimental conditions, the ECL intensity increases proportionally with the log of H2O2 and SNP concentration over the range from 0.2 μM-1000 μM and 0.08 mM-1.8 mM with the detection limits of 0.078 μM and 0.038 mM, respectively. The RSD for ten analyses of H2O2 is 4.25%. Recoveries from 97.2% to 101.7% were obtained for real sample analysis. Since H2O2 participates in numerous important enzymatic reactions, the application of this system was further investigated using glucose oxidase (GODx) and glucose as a representative enzyme and substrate, respectively, thus liberating H2O2 as a reaction product. The concentrations of glucose and the activity of GODx were directly proportional to the ECL intensities over a range of 5-1000 μM and 0.0025-1 units per mL with the limits of detection of 2.65 μM and 0.0012 units per mL (S/N = 3), respectively.
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Affiliation(s)
- Tadesse Haile Fereja
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun, Jilin 130022, P.R. China.
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Surowka AD, Gianoncelli A, Birarda G, Sala S, Cefarin N, Matruglio A, Szczerbowska-Boruchowska M, Ziomber-Lisiak A, Vaccari L. Soft X-ray induced radiation damage in thin freeze-dried brain samples studied by FTIR microscopy. JOURNAL OF SYNCHROTRON RADIATION 2020; 27:1218-1226. [PMID: 32876596 DOI: 10.1107/s1600577520010103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
In order to push the spatial resolution limits to the nanoscale, synchrotron-based soft X-ray microscopy (XRM) experiments require higher radiation doses to be delivered to materials. Nevertheless, the associated radiation damage impacts on the integrity of delicate biological samples. Herein, the extent of soft X-ray radiation damage in popular thin freeze-dried brain tissue samples mounted onto Si3N4 membranes, as highlighted by Fourier transform infrared microscopy (FTIR), is reported. The freeze-dried tissue samples were found to be affected by general degradation of the vibrational architecture, though these effects were weaker than those observed in paraffin-embedded and hydrated systems reported in the literature. In addition, weak, reversible and specific features of the tissue-Si3N4 interaction could be identified for the first time upon routine soft X-ray exposures, further highlighting the complex interplay between the biological sample, its preparation protocol and X-ray probe.
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Affiliation(s)
- Artur D Surowka
- Elettra-Sincrotrone Trieste SCpA, SS 14, km 163.5, Basovizza, TS 34149 Trieste, Italy
| | - A Gianoncelli
- Elettra-Sincrotrone Trieste SCpA, SS 14, km 163.5, Basovizza, TS 34149 Trieste, Italy
| | - G Birarda
- Elettra-Sincrotrone Trieste SCpA, SS 14, km 163.5, Basovizza, TS 34149 Trieste, Italy
| | - S Sala
- Elettra-Sincrotrone Trieste SCpA, SS 14, km 163.5, Basovizza, TS 34149 Trieste, Italy
| | - N Cefarin
- Elettra-Sincrotrone Trieste SCpA, SS 14, km 163.5, Basovizza, TS 34149 Trieste, Italy
| | - A Matruglio
- Department of Chemical Engineering, University College London, London, United Kingdom
| | - M Szczerbowska-Boruchowska
- AGH University of Science and Technology, Faculty of Physics and Applied Computer Science, al. Mickiewicza 30, Krakow 30-059, Poland
| | - A Ziomber-Lisiak
- Chair of Pathophysiology, Faculty of Medicine, Jagiellonian University, ul. Czysta 18, Kraków 31-121, Poland
| | - L Vaccari
- Elettra-Sincrotrone Trieste SCpA, SS 14, km 163.5, Basovizza, TS 34149 Trieste, Italy
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Management of Cerebral Salt-Wasting Syndrome and Syndrome of Inappropriate Antidiuresis in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Evaluation of the Relationship Between Serum Sodium Concentration and Mortality Rate in ICU Patients with Traumatic Brain Injury. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/ans.67845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dholke H, Campos A, Reddy C, Panigrahi M. Cerebral salt wasting syndrome. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2018. [DOI: 10.4103/2348-0548.190065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractTraumatic brain injury (TBI) is on the rise, especially in today’s fast-paced world. TBI requires not only neurosurgical expertise but also neurointensivist involvement for a better outcome. Disturbances of sodium balance are common in patients with brain injury, as the central nervous system plays a major role in sodium regulation. Hyponatraemia, defined as serum sodium <135 meq/L is commonly seen and is especially deleterious as it can contribute to cerebral oedema in these patients. Syndrome of inappropriate antidiuretic hormone secretion (SIADH), is the most well-known cause of hyponatraemia in this subset of patients. Cerebral Salt Wasting Syndrome (CSWS), leading to renal sodium loss is an important cause of hyponatraemia in patients with TBI. Although incompletely studied, decreased renal sympathetic responses and cerebral natriuretic factors play a role in the pathogenesis of CSWS. Maintaining a positive sodium balance and adequate hydration can help in the treatment. It is important to differentiate between SIADH and CSWS when trying to ascertain a case for patients with acute brain injury, as the treatment of the two are diametrically opposite.
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Affiliation(s)
- Harshal Dholke
- Department of Neuroanaesthesia and Critical Care, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Ann Campos
- Department of Neuroanaesthesia and Critical Care, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - C. Reddy
- Department of Neuroanaesthesia and Critical Care, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Wong YH, Wu CC, Wu JCC, Lai HY, Chen KY, Jheng BR, Chen MC, Chang TH, Chen BS. Temporal Genetic Modifications after Controlled Cortical Impact--Understanding Traumatic Brain Injury through a Systematic Network Approach. Int J Mol Sci 2016; 17:216. [PMID: 26861311 PMCID: PMC4783948 DOI: 10.3390/ijms17020216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/10/2015] [Indexed: 02/05/2023] Open
Abstract
Traumatic brain injury (TBI) is a primary injury caused by external physical force and also a secondary injury caused by biological processes such as metabolic, cellular, and other molecular events that eventually lead to brain cell death, tissue and nerve damage, and atrophy. It is a common disease process (as opposed to an event) that causes disabilities and high death rates. In order to treat all the repercussions of this injury, treatment becomes increasingly complex and difficult throughout the evolution of a TBI. Using high-throughput microarray data, we developed a systems biology approach to explore potential molecular mechanisms at four time points post-TBI (4, 8, 24, and 72 h), using a controlled cortical impact (CCI) model. We identified 27, 50, 48, and 59 significant proteins as network biomarkers at these four time points, respectively. We present their network structures to illustrate the protein–protein interactions (PPIs). We also identified UBC (Ubiquitin C), SUMO1, CDKN1A (cyclindependent kinase inhibitor 1A), and MYC as the core network biomarkers at the four time points, respectively. Using the functional analytical tool MetaCore™, we explored regulatory mechanisms and biological processes and conducted a statistical analysis of the four networks. The analytical results support some recent findings regarding TBI and provide additional guidance and directions for future research.
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Affiliation(s)
- Yung-Hao Wong
- College of Mechanical and Electronic Engineering, Fujian Agriculture and Forestry University, Fujian 350002, China.
- Laboratory of Control and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan.
- Institute of Biomedical Science, National Chung Hsing University, Taichung 402, Taiwan.
| | - Chia-Chou Wu
- Laboratory of Control and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan.
| | - John Chung-Che Wu
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan.
| | - Hsien-Yong Lai
- Institution Review Board (IRB), Christian Mennonite Hospital, Hualien 970, Taiwan.
| | - Kai-Yun Chen
- Graduate Institute of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan.
| | - Bo-Ren Jheng
- Laboratory of Control and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan.
| | - Mien-Cheng Chen
- Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung City 833, Taiwan.
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan.
| | - Bor-Sen Chen
- Laboratory of Control and Systems Biology, Department of Electrical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan.
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Abstract
Alkali metals, especially sodium and potassium, are plentiful and vital in biological systems. They take on important roles in health and disease. Such roles include the regulation of homeostasis, osmosis, blood pressure, electrolytic equilibria, and electric current. However, there is a limit to our present understanding; the ions have a great ability and capacity for action in health and disease, much greater than our current understanding. For the regulation of physiological homeostasis, there is a crucial regulator (renin-angiotensin system, RAS), found at both peripheral and central levels. Misregulation of the Na(+)-K(+) pump, and sodium channels in RAS are important for the understanding of disease progression, hypertension, diabetes, and neurodegenerative diseases, etc. In particular, RAS displays direct or indirect interaction important to Parkinson's disease (PD). In this chapter, the relationship between the regulation of sodium/potassium concentration and PD was sought. In addition, some recent biochemical and clinical findings are also discussed that help describe sodium and potassium in the context of traumatic brain injury (TBI). TBI is caused from the heavy striking of the head; this strongly affects ion flux in the affected tissue (brain) and damages cellular regulation systems. Thus, inappropriate concentrations of ions (hyper- and hyponatremia, and hyper- and hypokalemia) will perturb homeostasis giving rise to important and far reaching effects. These changes also impact osmotic pressure and the concentration of other metal ions, such as the calcium(II) ion.
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Diabetes Insipidus after Traumatic Brain Injury. J Clin Med 2015; 4:1448-62. [PMID: 26239685 PMCID: PMC4519799 DOI: 10.3390/jcm4071448] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/14/2015] [Accepted: 06/19/2015] [Indexed: 02/03/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in many age groups. Neuroendocrine dysfunction has been recognized as a consequence of TBI and consists of both anterior and posterior pituitary insufficiency; water and electrolyte abnormalities (diabetes insipidus (DI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH)) are amongst the most challenging sequelae. The acute head trauma can lead (directly or indirectly) to dysfunction of the hypothalamic neurons secreting antidiuretic hormone (ADH) or of the posterior pituitary gland causing post-traumatic DI (PTDI). PTDI is usually diagnosed in the first days after the trauma presenting with hypotonic polyuria. Frequently, the poor general status of most patients prevents adequate fluid intake to compensate the losses and severe dehydration and hypernatremia occur. Management consists of careful monitoring of fluid balance and hormonal replacement. PTDI is associated with high mortality, particularly when presenting very early following the injury. In many surviving patients, the PTDI is transient, lasting a few days to a few weeks and in a minority of cases, it is permanent requiring management similar to that offered to patients with non-traumatic central DI.
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Qi M, Luis V, Bilbao S, Omori K, Rawson J, McFadden B, Juan J, Nair I, Mullen Y, El-Shahawy M, Dafoe D, Kandeel F, Al-Abdullah IH. Sodium levels of human pancreatic donors are a critical factor for determination of islet efficacy and survival. Am J Physiol Endocrinol Metab 2015; 308:E362-9. [PMID: 25537495 DOI: 10.1152/ajpendo.00443.2014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Organs from hypernatremia (elevated Na+) donors when used for transplantation have had dismal outcomes. However, islet isolation from hypernatremic donors for both transplantation and research applications has not yet been investigated. A retrospective analysis of in vivo and in vitro islet function studies was performed on islets isolated from hypernatremic (serum sodium levels≥160 meq/l) and normal control (serum sodium levels≤155 meq/l) donors. Twelve isolations from 32 hypernatremic and 53 isolations from 222 normal donors were randomly transplanted into diabetic NOD Scid mice. Sodium levels upon pancreas procurement were significantly elevated in the hypernatremia group (163.5±0.6 meq/l) compared with the normal control group (145.9±0.4 meq/l) (P<0.001). The postculture islet recovery rate was significantly lower in the hypernatremia (59.1±3.8%) group compared with the normal (73.6±1.8%) group (P=0.005). The duration of hypernatremia was inversely correlated with the recovery rate (r2=0.370, P<0.001). Furthermore, the percentage of successful graft function when transplanted into diabetic NOD Scid mice was significantly lower in the hypernatremia (42%) group compared with the normal control (85%) group (P<0.001). The ability to predict islet graft function posttransplantation using donor sodium levels and duration of hypernatremia was significant (ROC analysis, P=0.022 and 0.042, respectively). In conclusion, duration of donor hypernatremia is associated with reduced islet recovery postculture. The efficacy of islets from hypernatremia donors diminished when transplanted into diabetic recipients.
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Affiliation(s)
- Meirigeng Qi
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Valiente Luis
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Shiela Bilbao
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Keiko Omori
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Jeffrey Rawson
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Brian McFadden
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Jemily Juan
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Indu Nair
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Yoko Mullen
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Mohamed El-Shahawy
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Donald Dafoe
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Fouad Kandeel
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
| | - Ismail H Al-Abdullah
- Department of Diabetes and Metabolic Diseases Research, Beckman Research Institute of the City of Hope, Duarte, California
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Medical acute complications of intracerebral hemorrhage in young adults. Stroke Res Treat 2015; 2015:357696. [PMID: 25722917 PMCID: PMC4333279 DOI: 10.1155/2015/357696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 12/15/2022] Open
Abstract
Background. Frequency and impact of medical complications on short-term mortality in young patients with intracerebral hemorrhage (ICH) have gone unstudied. Methods. We reviewed data of all first-ever nontraumatic ICH patients between 16 and 49 years of age treated in our hospital between January 2000 and March 2010 to identify medical complications suffered. Logistic regression adjusted for known ICH prognosticators was used to identify medical complications associated with mortality. Results. Among the 325 eligible patients (59% males, median age 42 [interquartile range 34–47] years), infections were discovered in 90 (28%), venous thrombotic events in 13 (4%), cardiac complications in 4 (1%), renal failure in 59 (18%), hypoglycemia in 15 (5%), hyperglycemia in 165 (51%), hyponatremia in 146 (45%), hypernatremia in 91 (28%), hypopotassemia in 104 (32%), and hyperpotassemia in 27 (8%). Adjusted for known ICH prognosticators and diabetes, the only independent complication associated with 3-month mortality was hyperglycemia (plasma glucose >8.0 mmol/L) (odds ratio: 5.90, 95% confidence interval: 2.25–15.48, P < 0.001). Three or more separate complications suffered also associated with increased mortality (7.76, 1.42–42.49, P = 0.018). Conclusions. Hyperglycemia is a frequent complication of ICH in young adults and is independently associated with increased mortality. However, multiple separate complications increase mortality even further.
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