1
|
Kim HY, Lee JD, Kim H, Kim Y, Park JJ, Oh SB, Goo H, Cho KJ, Kim KB. Mass spectrometry (MS)-based metabolomics of plasma and urine in dry eye disease (DED)-induced rat model. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2024:1-14. [PMID: 39185961 DOI: 10.1080/15287394.2024.2393770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Dry eye disease (DED) is an ophthalmic disease associated with poor quality and quantity of tears, and the number of patients is steadily increasing. The aim of this study was to determine plasma and urine metabolites obtained from DED scopolamine animal model where dry eye conditions (DRY) are induced. It was also of interest to examine whether DED (scopolamine) rat model was exacerbated by treatment with benzalkonium chloride (BAC). Subsequently, plasma and urine metabolites were analyzed using liquid chromatography (LC) and gas chromatography (GC)-mass spectrometry (MS), respectively. Data demonstrated that DED indicators such as tear volume, tear breakup time (TBUT), and corneal damage in the DED groups (DRY and BAC group) differed from those of control (CON). Similar results were noted in inflammatory factors such as interleukin (IL-1β), IL-6, and tumor necrosis factor (TNF)-α. In the partial least squares-discriminant analysis (PLS-DA) score plots, the three groups were distinctly separated from each other. In addition, the related metabolites were also associated with these distinct separations as evidenced by 9 and 14 in plasma and urine, respectively. Almost all of the selected metabolites were decreased in the DRY group compared to CON, and the BAC group was lower than the DRY. In plasma and urine, lysophosphatidylcholine/lysophosphatidylethanolamine, organic acids, amino acids, and sugars varied between three groups, and these metabolites were related to inflammation and oxidative stress. Data suggest that treatment with scopolamine with/without BAC-induced DED and affected the level of systemic metabolites involved in inflammation and oxidative stress.
Collapse
Affiliation(s)
- Hyang Yeon Kim
- College of Pharmacy, Dankook University, Cheonan, Chungnam, Republic of Korea
- Center for Human Risk Assessment, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Jung Dae Lee
- College of Pharmacy, Dankook University, Cheonan, Chungnam, Republic of Korea
- Center for Human Risk Assessment, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - HongYoon Kim
- College of Pharmacy, Dankook University, Cheonan, Chungnam, Republic of Korea
- Center for Human Risk Assessment, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - YuJin Kim
- College of Pharmacy, Dankook University, Cheonan, Chungnam, Republic of Korea
- Center for Human Risk Assessment, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Jin Ju Park
- College of Pharmacy, Dankook University, Cheonan, Chungnam, Republic of Korea
- Center for Human Risk Assessment, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Soo Bean Oh
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Hyeyoon Goo
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, College of Medicine, Dankook University, Cheonan, Chungnam, Republic of Korea
| | - Kyu-Bong Kim
- College of Pharmacy, Dankook University, Cheonan, Chungnam, Republic of Korea
- Center for Human Risk Assessment, Dankook University, Cheonan, Chungnam, Republic of Korea
| |
Collapse
|
2
|
Álvarez-Herms J. Summatory Effects of Anaerobic Exercise and a 'Westernized Athletic Diet' on Gut Dysbiosis and Chronic Low-Grade Metabolic Acidosis. Microorganisms 2024; 12:1138. [PMID: 38930520 PMCID: PMC11205432 DOI: 10.3390/microorganisms12061138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Anaerobic exercise decreases systemic pH and increases metabolic acidosis in athletes, altering the acid-base homeostasis. In addition, nutritional recommendations advising athletes to intake higher amounts of proteins and simple carbohydrates (including from sport functional supplements) could be detrimental to restoring acid-base balance. Here, this specific nutrition could be classified as an acidic diet and defined as 'Westernized athletic nutrition'. The maintenance of a chronic physiological state of low-grade metabolic acidosis produces detrimental effects on systemic health, physical performance, and inflammation. Therefore, nutrition must be capable of compensating for systemic acidosis from anaerobic exercise. The healthy gut microbiota can contribute to improving health and physical performance in athletes and, specifically, decrease the systemic acidic load through the conversion of lactate from systemic circulation to short-chain fatty acids in the proximal colon. On the contrary, microbial dysbiosis results in negative consequences for host health and physical performance because it results in a greater accumulation of systemic lactate, hydrogen ions, carbon dioxide, bacterial endotoxins, bioamines, and immunogenic compounds that are transported through the epithelia into the blood circulation. In conclusion, the systemic metabolic acidosis resulting from anaerobic exercise can be aggravated through an acidic diet, promoting chronic, low-grade metabolic acidosis in athletes. The individuality of athletic training and nutrition must take into consideration the acid-base homeostasis to modulate microbiota and adaptive physiological responses.
Collapse
Affiliation(s)
- Jesús Álvarez-Herms
- Phymolab, Physiology and Molecular Laboratory, 40170 Collado Hermoso, Segovia, Spain
| |
Collapse
|
3
|
Shen H, He Y, Lu F, Lu X, Yang B, Liu Y, Guo Q. Association of ratios of visceral fat area/subcutaneous fat area and muscle area/standard body weight at T12 CT level with the prognosis of acute respiratory distress syndrome. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2024; 2:106-118. [PMID: 39169930 PMCID: PMC11332858 DOI: 10.1016/j.pccm.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 08/23/2024]
Abstract
Background It is well-known that body composition metrics can influence the prognosis of various diseases. This study investigated how body composition metrics predict acute respiratory distress syndrome (ARDS) prognosis, focusing on the ratio of visceral fat area (VFA) to subcutaneous fat area (SFA), SFA to standard body weight (SBW), VFA to SBW, and muscle area (MA) to SBW. These metrics were assessed at the level of the twelfth thoracic vertebra (T12 computed tomography [CT] level) to determine their correlation with the outcomes of ARDS. The goal was to utilize these findings to refine and personalize treatment strategies for ARDS. Methods Patients with ARDS admitted to the intensive care units (ICUs) of three hospitals from January 2016 to July 2023 were enrolled in this study. Within 24 hours of ARDS onset, we obtained chest CT scans to measure subcutaneous fat, visceral fat, and muscle area at the T12 level. We then compared these ratios between survivors and non-survivors. Logistic regression was employed to identify prognostic risk factors. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal cutoff for predictors of in-hospital mortality. Based on this cutoff, patients with ARDS were stratified. To reduce confounding factors, 1:1 propensity score matching (PSM) was applied. We conducted analyses of clinical feature and prognostic differences pre- and post-PSM between the stratified groups. Additionally, Kaplan-Meier survival curves were generated to compare the survival outcomes of these groups. Results Of 258 patients with ARDS, 150 survived and 108 did not. Non-survivors had a higher VFA/SFA ratio (P <0.001) and lower SFA/SBW and MA/SBW ratios (both P <0.001). Key risk factors were high VFA/SFA ratio (OR=2.081; P=0.008), age, acute physiology and chronic health evaluation (APACHE) II score, and lactate levels, while MA/SBW and albumin were protective. Patients with a VFA/SFA ratio ≥0.73 were associated with increased mortality, while those with an MA/SBW ratio >1.55 cm²/kg had lower mortality, both pre- and post-PSM (P=0.001 and P <0.001, respectively). Among 170 patients with pulmonary-origin ARDS, 87 survived and 83 did not. The non-survivor group showed a higher VFA/SFA ratio (P <0.001) and lower SFA/SBW and MA/SBW (P=0.003, P <0.001, respectively). Similar risk and protective factors were observed in this cohort. For VFA/SFA, a value above the cutoff of 1.01 predicted higher mortality, while an MA/SBW value below the cutoff of 1.48 cm²/kg was associated with increased mortality (both P <0.001 pre-/post-PSM). Conclusions Among all patients with ARDS, the VFA to SFA ratio, MA to SBW ratio at the T12 level, age, APACHE II score, and lactate levels emerged as independent risk factors for mortality.
Collapse
Affiliation(s)
- Hui Shen
- Department of Emergency, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
| | - Ying He
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
| | - Fan Lu
- Department of Emergency, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
| | - Xiaoting Lu
- Department of Emergency, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
| | - Bining Yang
- Department of Emergency, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
| | - Yi Liu
- Department of Emergency, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
| | - Qiang Guo
- Department of Emergency, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu 215000, China
- Institute of Critical Care Medicine, Soochow University, Suzhou, Jiangsu 215000, China
- Medical Center of Soochow University, Suzhou, Jiangsu 215000, China
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| |
Collapse
|
4
|
Ecker Cohen O, Neuman S, Natan Y, Levy A, Blum YD, Amselem S, Bavli D, Ben Y. Amorphous calcium carbonate enhances osteogenic differentiation and myotube formation of human bone marrow derived mesenchymal stem cells and primary skeletal muscle cells under microgravity conditions. LIFE SCIENCES IN SPACE RESEARCH 2024; 41:146-157. [PMID: 38670641 DOI: 10.1016/j.lssr.2024.02.007] [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: 09/13/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 04/28/2024]
Abstract
Astronauts are exposed to severely stressful physiological conditions due to microgravity and increased space radiation. Space environment affects every organ and cell in the body and the significant adverse effects of long-term weightlessness include muscle atrophy and deterioration of the skeleton (spaceflight osteopenia). Amorphous Calcium Carbonate (ACC) emerges as a promising candidate for prevention of these effects, owing to its unique physicochemical properties and its potential to address the intricately linked nature of bone-muscle crosstalk. Reported here are two studies carried out on the International Space Station (ISS). The first, performed in 2018 as a part of the Ramon-Spacelab project, was a preliminary experiment, in which stromal murine cells were differentiated into osteoblasts when ACC was added to the culture medium. A parallel experiment was done on Earth as a control. The second study was part of Axiom-1's Rakia project mission launched to the ISS on 2022 utilizing organ-on-a-chip methodology with a specially designed autonomous module. In this experiment, human bone-marrow derived mesenchymal stem cells (hBM-MSCs) and human primary muscle cells were cultured in the presence or absence of ACC, in duplicates. The results showed that ACC enhanced differentiation of human primary skeletal muscle cells into myotubes. Similarly, hBM-MSCs were differentiated significantly better into osteocytes in the presence of ACC leading to increased calcium deposits. The results, combined with previous data, support the use of ACC as an advantageous supplement for preventing muscle and bone deterioration in outer space conditions, facilitating extended extraterrestrial voyages and colonization.
Collapse
Affiliation(s)
| | - Sara Neuman
- Amorphical LTD, 11 HaHarash St. Nes Ziona, 740318, Israel
| | - Yehudit Natan
- Amorphical LTD, 11 HaHarash St. Nes Ziona, 740318, Israel.
| | - Almog Levy
- SpacePharma R&D, 1 Abba Even Blvd, Herzliya, 4612003, Israel
| | - Yigal Dov Blum
- Amorphical LTD, 11 HaHarash St. Nes Ziona, 740318, Israel
| | - Shimon Amselem
- SpacePharma R&D, 1 Abba Even Blvd, Herzliya, 4612003, Israel
| | - Danny Bavli
- SpacePharma R&D, 1 Abba Even Blvd, Herzliya, 4612003, Israel
| | - Yossi Ben
- Amorphical LTD, 11 HaHarash St. Nes Ziona, 740318, Israel
| |
Collapse
|
5
|
Frassetto LA, Masharani U. Effects of Alterations in Acid-Base Effects on Insulin Signaling. Int J Mol Sci 2024; 25:2739. [PMID: 38473990 DOI: 10.3390/ijms25052739] [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: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Insulin tightly regulates glucose levels within a narrow range through its action on muscle, adipose tissue and the liver. The activation of insulin receptors activates multiple intracellular pathways with different functions. Another tightly regulated complex system in the body is acid-base balance. Metabolic acidosis, defined as a blood pH < 7.35 and serum bicarbonate < 22 mmol/L, has clear pathophysiologic consequences including an effect on insulin action. With the ongoing intake of typical acid-producing Western diets and the age-related decline in renal function, there is an increase in acid levels within the range considered to be normal. This modest increase in acidosis is referred to as "acid stress" and it may have some pathophysiological consequences. In this article, we discuss the effects of acid stress on insulin actions in different tissues.
Collapse
Affiliation(s)
- Lynda A Frassetto
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Umesh Masharani
- Department of Medicine, Division of Endocrinology, University of California San Francisco, San Francisco, CA 94143, USA
| |
Collapse
|
6
|
Choi S, Kim YJ, Oh H, Yuh WT, Lee CH, Yang SH, Kim CH, Chung CK, Park HP. Factors Associated With Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study. J Neurosurg Anesthesiol 2024; 36:45-52. [PMID: 36006663 DOI: 10.1097/ana.0000000000000867] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position. METHODS Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel. RESULTS Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI. CONCLUSIONS The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI.
Collapse
Affiliation(s)
| | | | | | - Woon Tak Yuh
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Heon Yang
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | |
Collapse
|
7
|
Klinkmann G, Waterstradt K, Klammt S, Schnurr K, Schewe JC, Wasserkort R, Mitzner S. Exploring Albumin Functionality Assays: A Pilot Study on Sepsis Evaluation in Intensive Care Medicine. Int J Mol Sci 2023; 24:12551. [PMID: 37628734 PMCID: PMC10454468 DOI: 10.3390/ijms241612551] [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: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Human serum albumin (HSA) as the most abundant plasma protein carries multifunctional properties. A major determinant of the efficacy of albumin relies on its potent binding capacity for toxins and pharmaceutical agents. Albumin binding is impaired in pathological conditions, affecting its function as a molecular scavenger. Limited knowledge is available on the functional properties of albumin in critically ill patients with sepsis or septic shock. A prospective, non-interventional clinical trial assessed blood samples from 26 intensive care patients. Albumin-binding capacity (ABiC) was determined by quantifying the unbound fraction of the fluorescent marker, dansyl sarcosine. Electron paramagnetic resonance fatty acid spin-probe evaluated albumin's binding and detoxification efficiencies. Binding efficiency (BE) reflects the strength and amount of bound fatty acids, and detoxification efficiency (DTE) indicates the molecular flexibility of patient albumin. ABiC, BE, and DTE effectively differentiated control patients from those with sepsis or septic shock (AUROC > 0.8). The diagnostic performance of BE showed similarities to procalcitonin. Albumin functionality correlates with parameters for inflammation, hepatic, or renal insufficiency. Albumin-binding function was significantly reduced in critically ill patients with sepsis or septic shock. These findings may help develop patient-specific algorithms for new diagnostic and therapeutic approaches.
Collapse
Affiliation(s)
- Gerd Klinkmann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, 18057 Rostock, Germany
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Extracorporeal Therapy Systems, Schillingallee 68, 18057 Rostock, Germany
| | - Katja Waterstradt
- Department of Research and Development, MedInnovation GmbH, 12487 Berlin, Germany
| | - Sebastian Klammt
- Division of Nephrology, Department of Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Kerstin Schnurr
- Department of Research and Development, MedInnovation GmbH, 12487 Berlin, Germany
| | - Jens-Christian Schewe
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Reinhold Wasserkort
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Extracorporeal Therapy Systems, Schillingallee 68, 18057 Rostock, Germany
- Division of Nephrology, Department of Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Steffen Mitzner
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Extracorporeal Therapy Systems, Schillingallee 68, 18057 Rostock, Germany
- Division of Nephrology, Department of Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| |
Collapse
|
8
|
Shen CY, Li KJ, Wu CH, Lu CH, Kuo YM, Hsieh SC, Yu CL. Unveiling the molecular basis of inflamm-aging induced by advanced glycation end products (AGEs)-modified human serum albumin (AGE-HSA) in patients with different immune-mediated diseases. Clin Immunol 2023:109655. [PMID: 37257547 DOI: 10.1016/j.clim.2023.109655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Increased serum advanced glycation end products (AGEs) are commonly found in the patients with Diabetes mellitus (DM), aging-related diseases, and immune-mediated diseases. These diseases are notorious for vasculopathy, immune dysfunctions, and low-grade inflammation mimicking inflamm-aging. However, the molecular basis of inflamm-aging related to AGEs remains elucidation. In this study, we incubated human serum albumin (HSA) and glucose at 37 °C in 5% CO2 incubator for 0-180 days to generate AGE-HSA. We found the mixture gradually changing the color from transparancy to brown color and increased molecular weight during incubation. The pH value also gradually decreased from 7.2 to 5.4 irrelevant to ionic charge or [Ca2+] concentration, but dependent on gradual glycation of the alkaline amino acids, lysine and arginine. Functionally, 40 μg/mL of AGE-HSA decreased IL-2 production from human Jurkat T cell line via suppressing p-STAT3, p-STAT4, and p-STAT6 with an increased tendency of senescence-associated β-galactosidase (SA-βgal) expression but irrelevant to change of Th1/Th2/Treg subpopulations. In contrast, AGE-HSA enhanced CC motif chemokine ligand 5 (CCL-5), IL-8, macrophage migration inhibitor factor (MIF), and interleukin 1 receptor antagonist (IL-1Ra) but suppressed SA-βgal expression by human macrophage-like THP-1 cells. Interestingly, AGE-HSA abrogated the HSA-induced soluble intercellular adhesion molecules 1 (sICAM-1), sE-selectin and endothelin release from human coronary artery endothelial cells (HCAEC) and enhanced SA-βgal expression. The accelerated and increased HSA glycations by individual inflammation-related cytokine such as IL-2, IL-6, IL-17, TGF-β, or TNF-α in the in vitro study reflect increased serum AGE levels in patients with immune-mediated diseases . In conclusion, AGE-HSA can exert immunosuppresive, inflammatory and vasculopathic effects mimicking inflamm-aging in these patients.
Collapse
Affiliation(s)
- Chieh-Yu Shen
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan; Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Ko-Jen Li
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Cheng-Han Wu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan; Department of Internal Medicine, National Taiwan University Hospital--Chu-Pei Branch, Chu-Pei 302, Taiwan.
| | - Cheng-Hsun Lu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan; Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Yu-Min Kuo
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan; Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Song-Chou Hsieh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| | - Chia-Li Yu
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan; Institute of Molecular Medicine, National Taiwan University College of Medicine, Taipei 10002, Taiwan.
| |
Collapse
|
9
|
Liu P, Li S, Zheng T, Wu J, Fan Y, Liu X, Gong W, Xie H, Liu J, Li Y, Jiang H, Zhao F, Zhang J, Wu L, Ren H, Hong Z, Chen J, Gu G, Wang G, Zhang Z, Wu X, Zhao Y, Ren J. Subphenotyping heterogeneous patients with chronic critical illness to guide individualised fluid balance treatment using machine learning: a retrospective cohort study. EClinicalMedicine 2023; 59:101970. [PMID: 37131542 PMCID: PMC10149181 DOI: 10.1016/j.eclinm.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/04/2023] Open
Abstract
Background The great heterogeneity of patients with chronic critical illness (CCI) leads to difficulty for intensive care unit (ICU) management. Identifying subphenotypes could assist in individualized care, which has not yet been explored. In this study, we aim to identify the subphenotypes of patients with CCI and reveal the heterogeneous treatment effect of fluid balance for them. Methods In this retrospective study, we defined CCI as an ICU length of stay over 14 days and coexists with persistent organ dysfunction (cardiovascular Sequential Organ Failure Assessment (SOFA) score ≥1 or score in any other organ system ≥2) at Day 14. Data from five electronic healthcare record datasets covering geographically distinct populations (the US, Europe, and China) were studied. These five datasets include (1) subset of Derivation (MIMIC-IV v1.0, US) cohort (2008-2019); (2) subset Derivation (MIMIC-III v1.4 'CareVue', US) cohort (2001-2008); (3) Validation I (eICU-CRD, US) cohort (2014-2015); (4) Validation II (AmsterdamUMCdb/AUMC, Euro) cohort (2003-2016); (5) Validation III (Jinling, CN) cohort (2017-2021). Patients who meet the criteria of CCI in their first ICU admission period were included in this study. Patients with age over 89 or under 18 years old were excluded. Three unsupervised clustering algorithms were employed independently for phenotypes derivation and validation. Extreme Gradient Boosting (XGBoost) was used for phenotype classifier construction. A parametric G-formula model was applied to estimate the cumulative risk under different daily fluid management strategies in different subphenotypes of ICU mortality. Findings We identified four subphenotypes as Phenotype A, B, C, and D in a total of 8145 patients from three countries. Phenotype A is the mildest and youngest subgroup; Phenotype B is the most common group, of whom patients showed the oldest age, significant acid-base abnormality, and low white blood cell count; Patients with Phenotype C have hypernatremia, hyperchloremia, and hypercatabolic status; and in Phenotype D, patients accompany with the most severe multiple organ failure. An easy-to-use classifier showed good effectiveness. Phenotype characteristics showed robustness across all cohorts. The beneficial fluid balance threshold intervals of subphenotypes were different. Interpretation We identified four novel phenotypes that revealed the different patterns and significant heterogeneous treatment effects of fluid therapy within patients with CCI. A prospective study is needed to validate our findings, which could inform clinical practice and guide future research on individualized care. Funding This study was funded by 333 High Level Talents Training Project of Jiangsu Province (BRA2019011), General Program of Medical Research from the Jiangsu Commission of Health (M2020052), and Key Research and Development Program of Jiangsu Province (BE2022823).
Collapse
Affiliation(s)
- Peizhao Liu
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Sicheng Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Tao Zheng
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
| | - Jie Wu
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
| | - Yong Fan
- Center for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing, 100039, China
| | - Xiaoli Liu
- Center for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing, 100039, China
| | - Wenbin Gong
- School of Medicine, Southeast University, Nanjing, 210002, China
| | - Haohao Xie
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
| | - Juanhan Liu
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yangguang Li
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Haiyang Jiang
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
| | - Fan Zhao
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jinpeng Zhang
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lei Wu
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huajian Ren
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhiwu Hong
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jun Chen
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Guosheng Gu
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Gefei Wang
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhengbo Zhang
- Center for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing, 100039, China
- Corresponding author. Centre for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing, China.
| | - Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Corresponding author. Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Yun Zhao
- Department of General Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China
- Corresponding author. Department of General Surgery, BenQ Medical Centre, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, China.
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Corresponding author. Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| |
Collapse
|
10
|
Huang C, Xiong H, Li W, Peng L, Zheng Y, Liao W, Zhou M, Xu Y. T cell activation profiles can distinguish gram negative/positive bacterial sepsis and are associated with ICU discharge. Front Immunol 2023; 13:1058606. [PMID: 36703970 PMCID: PMC9871918 DOI: 10.3389/fimmu.2022.1058606] [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: 09/30/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Sepsis is a life-threatening complication resulting from a dysregulated host response to a serious infection, of which bacteria are the most common cause. A rapid differentiation of the gram negative (G-)/gram positive (G+) pathogens facilitates antibiotic treatment, which in turn improves patients' survival. Methods We performed a prospective, observational study of adult patients in intensive care unit (ICU) unit and underwent the analysis of peripheral blood lymphocyte subsets, cytokines and other clinical indexes. The enrolled 94 patients were divided into no infection group (n=28) and bacterial sepsis group (n=66), and the latter group was subdivided into G- (n=46) and G+ (n=20) sepsis subgroups. Results The best immune biomarker which differentiated the diagnosis of G- sepsis from G+ sepsis, included activation markers of CD69, human leukocyte antigen DR (HLA-DR) on CD3+CD8+T subset. The ratio of CD3+CD4+CD69+T/CD3+CD8+CD69+T (odds ratio (OR): 0.078(0.012,0.506), P = 0.008), PCT>0.53 ng/ml (OR: 9.31(1.36,63.58), P = 0.023), and CO2CP<26.5 mmol/l (OR: 10.99(1.29, 93.36), P = 0.028) were predictive of G- sepsis (versus G+ sepsis), and the area under the curve (AUC) was 0.947. Additionally, the ratio of CD3+CD4+CD69+T/CD3+CD8+CD69+T ≤ 0.2697 was an independent risk factor for poor ICU discharge in G- sepsis patients (HR: 0.34 (0.13, 0.88), P=0.026). Conclusion We conclude that enhanced activation of T cells may regulate the excessive inflammatory response of G- bacterial sepsis, and that T cell activation profiles can rapidly distinguish G- sepsis from G+ sepsis and are associated with ICU discharge.
Collapse
Affiliation(s)
- Canxia Huang
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Xiong
- Department of Clinical Laboratory, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weichao Li
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lu Peng
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yukai Zheng
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenhua Liao
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Minggen Zhou
- Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Ying Xu, ; Minggen Zhou,
| | - Ying Xu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China,*Correspondence: Ying Xu, ; Minggen Zhou,
| |
Collapse
|
11
|
Alvarez MR, Alarcon JM, Roman CA, Lazaro D, Bobrowski-Khoury N, Baena-Caldas GP, Esber GR. Can a basic solution activate the inflammatory reflex? A review of potential mechanisms, opportunities, and challenges. Pharmacol Res 2023; 187:106525. [PMID: 36441036 DOI: 10.1016/j.phrs.2022.106525] [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: 08/31/2022] [Revised: 10/09/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022]
Abstract
Stimulation of the inflammatory reflex (IR) is a promising strategy to treat systemic inflammatory disorders. However, this strategy is hindered by the cost and side effects of traditional IR activators. Recently, oral intake of sodium bicarbonate (NaHCO3) has been suggested to activate the IR, providing a safe and inexpensive alternative. Critically, the mechanisms whereby NaHCO3 might achieve this effect and more broadly the pathways underlying the IR remain poorly understood. Here, we argue that the recognition of NaHCO3 as a potential IR activator presents exciting clinical and research opportunities. To aid this quest, we provide an integrative review of our current knowledge of the neural and cellular pathways mediating the IR and discuss the status of physiological models of IR activation. From this vantage point, we derive testable hypotheses on potential mechanisms whereby NaHCO3 might stimulate the IR and compare NaHCO3 with classic IR activators. Elucidation of these mechanisms will help determine the therapeutic value of NaHCO3 as an IR activator and provide new insights into the IR circuitry.
Collapse
Affiliation(s)
- Milena Rodriguez Alvarez
- Department of Internal Medicine, Division of Rheumatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Juan Marcos Alarcon
- Department of Pathology, The Robert F. Furchgott Center for Neural and Behavioral Science, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Christopher A Roman
- Department of Cell Biology, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Deana Lazaro
- Division of Rheumatology, Department of Internal Medicine, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA
| | | | | | | |
Collapse
|
12
|
Bahrampour N, Clark CCT. The relationship between dietary acid load and intensity of musculoskeletal pain condition: A population-based study. Food Sci Nutr 2022; 10:2542-2549. [PMID: 35959275 PMCID: PMC9361435 DOI: 10.1002/fsn3.2859] [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: 12/08/2021] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Pain is a globally prevalent problem, and a comprehension of its pathophysiology is important with respect to patient's health. Musculoskeletal pain conditions (MPs) may be associated with physical, lifestyle, and nutrition status, while dietary acid load (DAL) may be inversely associated with musculoskeletal health in adults. This cross-sectional study consisted of 175 adults experiencing pain. Anthropometric measurements, physical activity (PA), and pain intensity were assessed via specific questionnaires. Dietary data were collected using a 7-day 24-h recall. Foods and beverages were analyzed with Nutritionist IV software for extracting the total energy and nutrients. Net endogenous acid production (NEAP) and potential renal acid load (PRAL) were evaluated for assessing the DAL. Linear regression and Spearman correlation were used to investigate the association of exposure and input variables. Linear regression showed a positive relationship between PRAL and NEAP and pain intensity in the crude model. This significant positive relationship remained after adjusting for all confounders. A lower consumption of potassium, magnesium, vitamin B9 and C, and fiber was seen in the following quartiles of PRAL and NEAP. In addition, MPs intensity and PRAL and NEAP had a weak, positive correlation. This study suggests that a higher DAL may be associated with MPs. However, further research is needed.
Collapse
Affiliation(s)
- Niki Bahrampour
- Department of Nutrition, Science and Research BranchIslamic Azad University (SRBIAU)TehranIran
| | - Cain C. T. Clark
- Centre for Sport, Exercise, and Life SciencesCoventry UniversityCoventryUK
| |
Collapse
|
13
|
Foster VS, Rash LD, King GF, Rank MM. Acid-Sensing Ion Channels: Expression and Function in Resident and Infiltrating Immune Cells in the Central Nervous System. Front Cell Neurosci 2021; 15:738043. [PMID: 34602982 PMCID: PMC8484650 DOI: 10.3389/fncel.2021.738043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Peripheral and central immune cells are critical for fighting disease, but they can also play a pivotal role in the onset and/or progression of a variety of neurological conditions that affect the central nervous system (CNS). Tissue acidosis is often present in CNS pathologies such as multiple sclerosis, epileptic seizures, and depression, and local pH is also reduced during periods of ischemia following stroke, traumatic brain injury, and spinal cord injury. These pathological increases in extracellular acidity can activate a class of proton-gated channels known as acid-sensing ion channels (ASICs). ASICs have been primarily studied due to their ubiquitous expression throughout the nervous system, but it is less well recognized that they are also found in various types of immune cells. In this review, we explore what is currently known about the expression of ASICs in both peripheral and CNS-resident immune cells, and how channel activation during pathological tissue acidosis may lead to altered immune cell function that in turn modulates inflammatory pathology in the CNS. We identify gaps in the literature where ASICs and immune cell function has not been characterized, such as neurotrauma. Knowledge of the contribution of ASICs to immune cell function in neuropathology will be critical for determining whether the therapeutic benefits of ASIC inhibition might be due in part to an effect on immune cells.
Collapse
Affiliation(s)
- Victoria S. Foster
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - Lachlan D. Rash
- School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Glenn F. King
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
- Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Queensland, St Lucia, QLD, Australia
| | - Michelle M. Rank
- Anatomy and Physiology, Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
14
|
Shevel E. Conditions Favoring Increased COVID-19 Morbidity and Mortality: Their Common Denominator and its Early Treatment. MISSOURI MEDICINE 2021; 118:113-115. [PMID: 33840847 PMCID: PMC8029622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The factors contributing to increased morbidity and mortality in SARS-CoV-2 infection are diverse, and include diabetes, obesity, Chronic Obstructive Pulmonary Disease (COPD), advanced age, and male sex. Although there is no obvious connection between these, they do have one common denominator-they all have a tendency towards lower urine pH, which may indicate a lower-than-normal tissue pH. Furthermore, it has been shown that lower pH has two important negative influences: 1) it enhances viral fusion via the endosomal route, thereby facilitating viral multiplication; and 2) it facilitates increased production of inflammatory cytokines, thereby exacerbating the cytokine storm. This paper discusses published literature on lower tissue/interstitial pH in those diseases/co-morbidities that are known risk factors of severe COVID-19, and hypothesize that small doses of baking soda could be a simple, cost-effective, and rapid method of reducing both morbidity and mortality in COVID-19 patients.
Collapse
Affiliation(s)
- Eliot Shevel
- Head of the South African Headache Society, the South African affiliate of the International Headache Society. He is founder and practices at The Headache Clinic in Johannesburg, South Africa
| |
Collapse
|
15
|
Affiliation(s)
- Xianlei Li
- Department of Biomedical Engineering National University of Singapore 117583 Singapore
| | - Yufeng Shou
- Department of Biomedical Engineering National University of Singapore 117583 Singapore
| | - Andy Tay
- Department of Biomedical Engineering National University of Singapore 117583 Singapore
- Institute for Health Innovation and Technology National University of Singapore 117599 Singapore
| |
Collapse
|
16
|
Liu J, Wei E, Wei J, Zhou W, Webster KA, Zhang B, Li D, Zhang G, Wei Y, Long Y, Qi X, Zhang Q, Xu D. MiR-126-HMGB1-HIF-1 Axis Regulates Endothelial Cell Inflammation during Exposure to Hypoxia-Acidosis. DISEASE MARKERS 2021; 2021:4933194. [PMID: 34970357 PMCID: PMC8714334 DOI: 10.1155/2021/4933194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/20/2021] [Indexed: 02/05/2023]
Abstract
Crosstalk between molecular regulators miR-126, hypoxia-inducible factor 1-alpha (HIF-1-α), and high-mobility group box-1 (HMGB1) contributes to the regulation of inflammation and angiogenesis in multiple physiological and pathophysiological settings. Here, we present evidence of an overriding role for miR-126 in the regulation of HMGB1 and its downstream proinflammatory effectors in endothelial cells subjected to hypoxia with concurrent acidosis (H/A). Methods. Primary mouse endothelial cells (PMEC) were exposed to hypoxia or H/A to simulate short or chronic low-flow ischemia, respectively. RT-qPCR quantified mRNA transcripts, and proteins were measured by western blot. ROS were quantified by fluorogenic ELISA and luciferase reporter assays employed to confirm an active miR-126 target in the HMGB1 3'UTR. Results. Enhanced expression of miR-126 in PMECs cultured under neutral hypoxia was suppressed under H/A, whereas the HMGB1 expression increased sequentially under both conditions. Enhanced expression of HMGB1 and downstream inflammation markers was blocked by the premiR-126 overexpression and optimized by antagomiR. Compared with neutral hypoxia, H/A suppressed the HIF-1α expression independently of miR-126. The results show that HMGB1 and downstream effectors are optimally induced by H/A relative to neutral hypoxia via crosstalk between hypoxia signaling, miR-126, and HIF-1α, whereas B-cell lymphoma 2(Bcl2), a HIF-1α, and miR-126 regulated gene expressed optimally under neutral hypoxia. Conclusion. Inflammatory responses of ECs to H/A are dynamically regulated by the combined actions of hypoxia, miR-126, and HIF-1α on the master regulator HMGB1. The findings may be relevant to vascular diseases including atherosclerotic occlusion and interiors of plaque where coexisting hypoxia and acidosis promote inflammation as a defining etiology.
Collapse
Affiliation(s)
- Jinxue Liu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Eileen Wei
- Gulliver High School, Miami, FL 33156, USA
| | - Jianqin Wei
- Department of Medicine Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Wei Zhou
- Department of Ophthalmology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen 529030, China
| | - Keith A. Webster
- Integene International, LLC, Miami, FL 33137, USA
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX 77030, USA
- Everglades Biopharma, LLC, Houston, TX 77030, USA
| | - Bin Zhang
- Department of Cardiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen 529030, China
| | - Dong Li
- Department of Intensive Care Unit and Clinical Experimental Center, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen 529030, China
| | - Gaoxing Zhang
- Department of Cardiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen 529030, China
| | - Yidong Wei
- Department of Surgery, Youjiang Medical University for Nationalities, Chengxiang Rd, Baise, Guangxi 533000, China
| | - Yusheng Long
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510080, China
- Department of Cardiology, Guangdong Cardiovascular Institute and Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Xiuyu Qi
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510080, China
- Department of Cardiology, Guangdong Cardiovascular Institute and Shantou University Medical College, Shantou 515041, China
| | - Qianhuan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangzhou 510080, China
| | - Dingli Xu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
17
|
Acid-base variables in acute and chronic form of nontuberculous mycobacterial infection in growing goats experimentally inoculated with Mycobacterium avium subsp. hominissuis or Mycobacterium avium subsp. paratuberculosis. PLoS One 2020; 15:e0243892. [PMID: 33315933 PMCID: PMC7735625 DOI: 10.1371/journal.pone.0243892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
In current literature, data assessing the acid-base equilibrium in animals and humans during bacterial infection are rare. This study aimed to evaluate acid-base deteriorations in growing goats with experimentally induced NTM (nontuberculous mycobacteria) infections by application of the traditional Henderson-Hasselbalch approach and the strong ion model. NTM-challenged animals were orally inoculated with either Mycobacterium avium subsp. hominissuis (MAH; n = 18) or Mycobacterium avium subsp. paratuberculosis (MAP; n = 48). Twenty-five goats served as non-infected controls. Until 51st week post-inoculation (wpi), blood gas analysis, serum biochemical analysis, and serum electrophoresis were performed on venous blood. Fifty percent (9/18) of goats inoculated with MAH developed acute clinical signs like apathy, fever, and diarrhea. Those animals died or had to be euthanized within 11 weeks post-inoculation. This acute form of NTM-infection was characterized by significantly lower concentrations of sodium, calcium, albumin, and total protein, as well as significantly higher concentrations of gamma globulin, associated with reduced albumin/globulin ratio. Acid-base status indicated alkalosis, but normal base excess and HCO3- concentrations, besides significantly reduced levels of SID (strong ion difference), Atot Alb (total plasma concentration of weak non-volatile acids, based on albumin), Atot TP (Atot based on total protein) and markedly lower SIG (strong ion gap). The remaining fifty percent (9/18) of MAH-infected goats and all goats challenged with MAP survived and presented a more sub-clinical, chronic form of infection mainly characterized by changes in serum protein profiles. With the progression of the disease, concentrations of gamma globulin, and total protein increased while albumin remained lower compared to controls. Consequently, significantly reduced albumin/globulin ratio and lower Atot Alb as well as higher Atot TP were observed. Changes were fully compensated with no effect on blood pH. Only the strong ion variables differentiated alterations in acid-base equilibrium during acute and chronic NTM-infection.
Collapse
|
18
|
Huber W, Lorenz G, Heilmaier M, Böttcher K, Sahm P, Middelhoff M, Ritzer B, Schulz D, Bekka E, Hesse F, Poszler A, Geisler F, Spinner C, Schmid RM, Lahmer T. Extracorporeal multiorgan support including CO 2-removal with the ADVanced Organ Support (ADVOS) system for COVID-19: A case report. Int J Artif Organs 2020; 44:288-294. [PMID: 32985328 PMCID: PMC8041450 DOI: 10.1177/0391398820961781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A substantial part of COVID-19-patients suffers from multi-organ failure (MOF). We report on an 80-year old patient with pulmonary, renal, circulatory, and hepatic failure. We decided against the use of extracorporeal membrane oxygenation (ECMO) due to old age and a SOFA-score of 13. However, the patient was continuously treated with the extracorporeal multi-organ- “ADVanced Organ Support” (ADVOS) device (ADVITOS GmbH, Munich, Germany). During eight 24h-treatment-sessions blood flow (100–300 mL/min), dialysate flow (160–320 mL/min) and dialysate pH (7.6–9.0) were adapted to optimize arterial PaCO2 and pH. Effective CO2 removal and correction of acidosis could be demonstrated by mean arterial- versus post-dialyzer values of pCO2 (68.7 ± 13.8 vs. 26.9 ± 11.6 mmHg; p < 0.001). The CO2-elimination rate was 48 ± 23mL/min. The initial vasopressor requirement could be reduced in parallel to pH-normalization. Interruptions of ADVOS-treatment repeatedly resulted in reversible deteriorations of paCO2 and pH. After 95 h of continuous extracorporeal decarboxylating therapy the patient had markedly improved circulatory parameters compared to baseline. In the context of secondary pulmonary infection and progressive liver failure, the patient had a sudden cardiac arrest. In accordance with the presumed patient will, we decided against mechanical resuscitation. Irrespective of the outcome we conclude that extracorporeal CO2 removal and multiorgan-support were feasible in this COVID-19-patient. Combined and less invasive approaches such as ADVOS might be considered in old-age-COVID-19 patients with MOF.
Collapse
Affiliation(s)
- Wolfgang Huber
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Georg Lorenz
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany.,Abteilung für Nephrologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Markus Heilmaier
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Katrin Böttcher
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Philipp Sahm
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Moritz Middelhoff
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Barbara Ritzer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Dominik Schulz
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Elias Bekka
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Felix Hesse
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Alexander Poszler
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Fabian Geisler
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Christoph Spinner
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Roland M Schmid
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Tobias Lahmer
- Medizinische Klinik und Poliklinik II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| |
Collapse
|
19
|
Bihari S, Bannard-Smith J, Bellomo R. Albumin as a drug: its biological effects beyond volume expansion. CRIT CARE RESUSC 2020; 22:257-265. [PMID: 32900333 PMCID: PMC10692529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Albumin is the most abundant and perhaps most important protein in human blood. Research has identified many of albumin's possible roles in modulating acid-base balance, modifying inflammation, maintaining vascular endothelial integrity, and binding endogenous and exogenous compounds. Albumin plays a key role in the homeostasis of vascular endothelium, offering protection from inflammation and damage to the glycocalyx. Albumin binds a diverse range of compounds. It transports, delivers and clears drugs, plus it helps with uptake, storage and disposal of potentially harmful biological products. The biological effects of albumin in critical illness are incompletely understood, but may enhance its clinical role beyond use as an intravenous fluid. In this article, we summarise the evidence surrounding albumin's biological and physiological effects beyond its use for plasma volume expansion, and explore potential mechanistic effects of albumin as a disease modifier in patients with critical illness.
Collapse
Affiliation(s)
- Shailesh Bihari
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia. ,
| | - Jonathan Bannard-Smith
- Department of Critical Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
20
|
Bihari S, Bannard-Smith J, Bellomo R. Albumin as a drug: its biological effects beyond volume expansion. CRIT CARE RESUSC 2020; 22:257-265. [PMID: 32900333 PMCID: PMC10692529 DOI: 10.1016/s1441-2772(23)00394-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Albumin is the most abundant and perhaps most important protein in human blood. Research has identified many of albumin's possible roles in modulating acid-base balance, modifying inflammation, maintaining vascular endothelial integrity, and binding endogenous and exogenous compounds. Albumin plays a key role in the homeostasis of vascular endothelium, offering protection from inflammation and damage to the glycocalyx. Albumin binds a diverse range of compounds. It transports, delivers and clears drugs, plus it helps with uptake, storage and disposal of potentially harmful biological products. The biological effects of albumin in critical illness are incompletely understood, but may enhance its clinical role beyond use as an intravenous fluid. In this article, we summarise the evidence surrounding albumin's biological and physiological effects beyond its use for plasma volume expansion, and explore potential mechanistic effects of albumin as a disease modifier in patients with critical illness.
Collapse
Affiliation(s)
- Shailesh Bihari
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, SA, Australia. ,
| | - Jonathan Bannard-Smith
- Department of Critical Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
21
|
Shi C, Wang X, Wang L, Meng Q, Guo D, Chen L, Dai M, Wang G, Cooney R, Luo J. A nanotrap improves survival in severe sepsis by attenuating hyperinflammation. Nat Commun 2020; 11:3384. [PMID: 32636379 PMCID: PMC7341815 DOI: 10.1038/s41467-020-17153-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/08/2020] [Indexed: 02/07/2023] Open
Abstract
Targeting single mediators has failed to reduce the mortality of sepsis. We developed a telodendrimer (TD) nanotrap (NT) to capture various biomolecules via multivalent, hybrid and synergistic interactions. Here, we report that the immobilization of TD-NTs in size-exclusive hydrogel resins simultaneously adsorbs septic molecules, e.g. lipopolysaccharides (LPS), cytokines and damage- or pathogen-associated molecular patterns (DAMPs/PAMPs) from blood with high efficiency (92-99%). Distinct surface charges displayed on the majority of pro-inflammatory cytokines (negative) and anti-inflammatory cytokines (positive) allow for the selective capture via TD NTs with different charge moieties. The efficacy of NT therapies in murine sepsis is both time-dependent and charge-dependent. The combination of the optimized NT therapy with a moderate antibiotic treatment results in a 100% survival in severe septic mice by controlling both infection and hyperinflammation, whereas survival are only 50-60% with the individual therapies. Cytokine analysis, inflammatory gene activation and tissue histopathology strongly support the survival benefits of treatments.
Collapse
Affiliation(s)
- Changying Shi
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Xiaojing Wang
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Lili Wang
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Qinghe Meng
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Dandan Guo
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Li Chen
- Department of Pathology, Baylor Scott and White Medical Center, Temple, TX, 76508, USA
| | - Matthew Dai
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
- Brown University, Providence, RI, 02912, USA
| | - Guirong Wang
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
- Sepsis Interdisciplinary Research Center, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Robert Cooney
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
- Sepsis Interdisciplinary Research Center, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA
| | - Juntao Luo
- Department of Pharmacology, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA.
- Department of Surgery, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA.
- Sepsis Interdisciplinary Research Center, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA.
- Upstate Cancer Center, State University of New York Upstate Medical University, Syracuse, NY, 13210, USA.
| |
Collapse
|
22
|
Burchell RK, Gal A, Friedlein R, Leisewitz AL. Role of electrolyte abnormalities and unmeasured anions in the metabolic acid-base abnormalities in dogs with parvoviral enteritis. J Vet Intern Med 2020; 34:857-866. [PMID: 32133703 PMCID: PMC7096617 DOI: 10.1111/jvim.15749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The strong ion model (SIM) is an alternative paradigm in the characterization of acid-base disturbances particularly in complex disorders. HYPOTHESIS/OBJECTIVES To compare the acid-base changes in dogs with parvoviral enteritis (PE) using the Henderson-Hasselbalch (HH) approach, with 2 strong ion approaches. ANIMALS Forty-four dogs with PE, and 16 age-matched control dogs. METHODS Prospective controlled observational study. Acid-base status was evaluated using the HH model, Fencl-Stewart (FS) approach and a validated strong ion model (VDM). The acid-base changes according to each model were classified and compared. Statistical correlations between pH, CO2 , and various SIM variables were performed, as well as between the sum of effects (SOE) of the SIM and the individual variables comprising the SOE. RESULTS The HH model identified acid-base disorders in 31/44 cases of which 16/31 were mixed with metabolic acidosis and concurrent respiratory alkalosis the most common (10/31). Using the FS approach, metabolic changes were present 36/42 cases, with changes in free water (FW), chloride, and unmeasured anions (UA) being the most prevalent. Both FW and UA correlated well with pH; however, UA were most consistently abnormal in severe acidemia. Similarly to the HH, the VDM detected acid-base disturbances in 28/44 cases. Major contributors to the acid-base changes were hyponatremia, hypochloremia, and Atot acidosis because of elevated globulins and increased UA. CONCLUSIONS AND CLINICAL IMPORTANCE Acid-base changes are common and complex in dogs with PE, and were easier to understand using a SIM paradigm. Increases in UA have not been documented in PE in dogs.
Collapse
Affiliation(s)
- Richard K Burchell
- Veterinary and Biomedical Sciences, James Cook University, Townsville, Queensland, Australia
| | - Arnon Gal
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Ryan Friedlein
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Andrew L Leisewitz
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
23
|
Kurteva E, Lindley KJ, Hill SM, Köglmeier J. Mucosal Abnormalities in Children With Congenital Chloride Diarrhea-An Underestimated Phenotypic Feature? Front Pediatr 2020; 8:365. [PMID: 32850522 PMCID: PMC7403178 DOI: 10.3389/fped.2020.00365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/01/2020] [Indexed: 01/12/2023] Open
Abstract
Objectives and Study: Congenital chloride diarrhea (CCD) is a rare, autosomal recessive disorder caused by mutations in the SLC26A3 gene encoding a transmembrane chloride/bicarbonate ion exchanger mainly expressed in the apical brush border of the ileal and colonic epithelium. Lifelong, secretory, chloride-rich diarrhea and hypochloremic, hypokalemic metabolic alkalosis are characteristic. Histological evidence of bowel inflammation is not typically described in CCD and has only been reported in a few patients. Methods: We report four cases of CCD who received adequate resuscitation with appropriate replacement of their fecal salt and water losses. Three had associated inflammatory bowel changes at endoscopy. The index case of CCD who developed frankly bloodstained diarrhea aged 7 months was found to have histologically confirmed colitis at endoscopy. An electronic search of the hospital database to identify all patients with confirmed CCD was performed. A further three children underwent de novo diagnostic evaluation and treatment. A retrospective case note review was undertaken to determine the incidence and subtype of inflammatory bowel disease (IBD) by clinical, endoscopic, and histological means. Results: Four children with genetically confirmed CCD were identified, two being female. The first girl had a granulomatous colitis with ulceration. She went into remission with a combination of steroids and azathioprine. Immunosuppression was subsequently discontinued without a further flare of colitis. A second girl was found to have patchy inflammatory changes in the small bowel and focal active colitis. A third patient, a boy, demonstrated mild inflammatory changes in the small bowel with apoptotic debris and mild inflammation in the colon. A fourth patient did not develop intestinal inflammation. Conclusion: Our case series highlights the potential association of CCD with panenteric inflammation. While our cohort was small, CCD is rare and three out of four children referred to our tertiary referral center were affected. While early diagnosis and adequate salt replacement therapy are crucial in CCD management, the clinician should also be aware of bowel inflammation as a potential cause of failure of CCD therapy to control bowel symptomatology. Further insight is needed to understand the underlying patho-mechanism giving rise to bowel inflammation in this group.
Collapse
Affiliation(s)
- Elena Kurteva
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Keith J Lindley
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Susan M Hill
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jutta Köglmeier
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
24
|
Perez Ruiz de Garibay A, Kellum JA, Honigschnabel J, Kreymann B. Respiratory and metabolic acidosis correction with the ADVanced Organ Support system. Intensive Care Med Exp 2019; 7:56. [PMID: 31535309 PMCID: PMC6751235 DOI: 10.1186/s40635-019-0269-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023] Open
Abstract
Background The lung, the kidney, and the liver are major regulators of acid-base balance. Acidosis due to the dysfunction of one or more organs can increase mortality, especially in critically ill patients. Supporting compensation by increasing ventilation or infusing bicarbonate is often ineffective. Therefore, direct removal of acid may represent a novel therapeutic approach. This can be achieved with the ADVanced Organ Support (ADVOS) system, an enhanced renal support therapy based on albumin dialysis. Here, we demonstrate proof of concept for this technology. Methods An ex vivo model of either hypercapnic (i.e., continuous CO2 supply) or lactic acidosis (i.e., lactic acid infusion) using porcine blood was subjected to hemodialysis with ADVOS. A variety of operational parameters including blood and dialysate flows, different dialysate pH settings, and acid and base concentrate compositions were tested. Comparisons with standard continuous veno-venous hemofiltration (CVVH) using high bicarbonate substitution fluid and continuous veno-venous hemodialysis (CVVHD) were also performed. Results Sixty-one milliliters per minute (2.7 mmol/min) of CO2 was removed using a blood flow of 400 ml/min and a dialysate pH of 10 without altering blood pCO2 and HCO3− (36 mmHg and 20 mmol/l, respectively). Up to 142 ml/min (6.3 mmol/min) of CO2 was eliminated if elevated pCO2 (117 mmHg) and HCO3− (63 mmol/l) were allowed. During continuous lactic acid infusion, an acid load of up to 3 mmol/min was compensated. When acidosis was triggered, ADVOS multi normalized pH and bicarbonate levels within 1 h, while neither CVVH nor CVVHD could. The major determinants to correct blood pH were blood flow, dialysate composition, and initial acid-base status. Conclusions In conclusion, ADVOS was able to remove more than 50% of the amount of CO2 typically produced by an adult human. Blood pH was maintained stable within the physiological range through compensation of a metabolic acid load by albumin dialysate. These in vitro results will require confirmation in patients.
Collapse
Affiliation(s)
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | | |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW To describe recent advances in the understanding of the role of fluid composition in renal outcomes in critically ill patients. RECENT FINDINGS The debate on fluid composition is now focused in a pragmatic discussion on fluid electrolyte composition. The resurgence of this debate was propelled by several observational studies that suggested that balanced (i.e., low chloride) solutions were associated with less acute kidney injury in critically ill patients. Nevertheless, a cluster randomized trial failed to show any benefit of balanced solutions. This trial, however, may have failed to detect an effect because of low global illness severity and little fluid infused. If balanced solutions are to be associated with less acute kidney injury, it will probably be in high risk, aggressively resuscitated patients. Additionally, the causal loop involving unbalanced solution infusion, induction of hyperchloremia and acute kidney injury is yet to be closed. Other factors, such as buffer type, speed of infusion and temperature, among others, may also be important. SUMMARY Recent evidence suggests that crystalloid fluid composition matters and can influence renal outcomes in critically ill patients. Further studies should assess the impact and cost-efficiency of balanced solutions in the context of high-risk scenarios.
Collapse
|
26
|
Casimir GJ, Lefèvre N, Corazza F, Duchateau J, Chamekh M. The Acid-Base Balance and Gender in Inflammation: A Mini-Review. Front Immunol 2018; 9:475. [PMID: 29593728 PMCID: PMC5854649 DOI: 10.3389/fimmu.2018.00475] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/22/2018] [Indexed: 12/31/2022] Open
Abstract
In humans, acid–base balance is crucial to cell homeostasis. Acidosis is observed in numerous inflammatory processes, primarily acute conditions such as sepsis, trauma, or acute respiratory distress where females tend to exhibit better prognosis compared with males. The mechanisms underlying these gender-dependent differences are multiple, probably involving hormonal and genetic factors, particularly the X chromosome. Although pH influences multiple immunological functions, gender differences in acid–base balance have been poorly investigated. In this review, we provide an update on gender differences in human susceptibility to inflammatory diseases. We additionally discuss the potential impact of acid–base balance on the gender bias of the inflammatory response in view of our recent observation that girls present higher neutrophilic inflammation and lower pH with a trend toward better prognosis in severe sepsis. We also highlight the potent role played by endothelial cells in gender differences of inflammation through activation of proton-sensing G protein-coupled receptors.
Collapse
Affiliation(s)
- Georges Jacques Casimir
- Laboratoire académique de Pédiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Lefèvre
- Laboratoire académique de Pédiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.,Laboratoire de Médecine translationnelle, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Francis Corazza
- Laboratoire de Médecine translationnelle, Centre Hospitalier Universitaire Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Duchateau
- Laboratoire académique de Pédiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Mustapha Chamekh
- Laboratoire académique de Pédiatrie, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
27
|
Hydroxyethyl starch is associated with early postoperative delirium in patients undergoing esophagectomy. J Thorac Cardiovasc Surg 2018; 155:1333-1343. [DOI: 10.1016/j.jtcvs.2017.10.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/22/2017] [Accepted: 10/23/2017] [Indexed: 12/16/2022]
|
28
|
Sex Differences in Inflammatory Response and Acid-Base Balance in Prepubertal Children with Severe Sepsis. Shock 2018; 47:422-428. [PMID: 27755508 DOI: 10.1097/shk.0000000000000773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE AND METHODS The severity and prognosis of various acute inflammatory conditions, such as sepsis, differ between males and females. The mechanisms underlying these sex differences probably involve both hormonal and genetic factors. In order to evaluate a possible genetic influence, we reviewed clinical signs and biological inflammatory markers of prepubertal children with severe sepsis admitted to the pediatric intensive care unit (PICU). FINDINGS A total of 142 prepubertal children, 66 girls and 76 boys, suffering from severe sepsis and admitted to the PICU were included. The survival rate demonstrated a tendency to be higher in females (P = 0.14). Maximum white blood cell count (23,800 cells/μL [15,110-34,600] in girls vs. 19,025 cells/μL [12,358-26,098] in boys, P = 0.02), neutrophil count (16,944 cells/μL [10,620-27,540] vs. 13,756 cells/μL [8410-20,110], P = 0.03), and C-reactive protein level (26.2 mg/dL [15.7-33.6] vs. 18.8 mg/dL [11.1-30.0], P = 0.04) were all significantly higher in girls. Girls also exhibited significantly longer fever duration (2 days [1-6] vs. 1 day [1-3] for the boys, P <0.01), lower pH on admission (7.32 [7.25-7.39] vs. 7.37 [7.31-7.43] P = 0.03), and lower base excess (-6 mEq/L [-10.7 to -0.8] vs. -2.3 mEq/L [-6.6 to -2.6], P <0.01), as well as lower bicarbonate levels (19.1 mEq/l [15.9-24.0] vs. 21.15 mEq/l [18.3-26.68], P = 0.04), when compared with the boys. CONCLUSIONS Our study revealed higher neutrophilic inflammation, as well as lower pH on admission, in girls with severe sepsis; associated with longer fever duration, which could contribute to better pathogen clearance. However, further studies are needed to demonstrate the link between acidosis and modulation of the immune response.
Collapse
|
29
|
Pongmanee W, Vattanavanit V. Can base excess and anion gap predict lactate level in diagnosis of septic shock? Open Access Emerg Med 2017; 10:1-7. [PMID: 29302195 PMCID: PMC5741987 DOI: 10.2147/oaem.s153402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Lactate measurement is the key component in septic shock identification and resuscitation. However, point-of-care lactate testing is not widely used due to the lack of access to nearby test equipment. Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) are used in determining shock in patients with seemingly normal vital signs. Purpose We aimed to determine if these biomarkers can be used interchangeably in patients with septic shock in the emergency setting. Patients and methods A prospective observational cohort study was undertaken at a tertiary hospital in southern Thailand. Baseline point-of-care BE, AG, and serum lactate were recorded in all patients presenting with septic shock at the emergency department. Overall correlations including area under the receiver operating characteristic curve (AUROC) for both BE and AG to predict serum lactate level were calculated. Results One hundred and fifteen patients were enrolled. Pearson correlation of serum lactate to BE was −0.59 (r2 = 0.35; 95% confidence interval [CI], −0.69 to −0.44; P < 0.001) and BE to AG was −0.67 (r2 = 0.49; 95% CI, −0.76 to −0.55; P < 0.001), and serum lactate to AG was 0.64 (r2 = 0.41; 95% CI, 0.52 to 0.74; P < 0.001). A cut-off point of 15.8 for AG identified a lactate level ≥2 mmol/L (sensitivity, 71.4%; specificity, 80.7%; and AUROC, 0.76), and the best cut-off value to predict a lactate level ≥4 mmol/L was 18.5 (sensitivity, 64.2%; specificity, 85.5%; and AUROC 0.78). Conclusion In patients with septic shock, lactate and AG showed a strong correlation with each other, whereas lactate and BE showed a moderate correlation with each other. Thus, these biomarkers can be used interchangeably to help determine septic shock earlier in patients.
Collapse
Affiliation(s)
| | - Veerapong Vattanavanit
- Division of Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
30
|
Ferrer R, Mateu X, Maseda E, Yébenes JC, Aldecoa C, De Haro C, Ruiz-Rodriguez JC, Garnacho-Montero J. Non-oncotic properties of albumin. A multidisciplinary vision about the implications for critically ill patients. Expert Rev Clin Pharmacol 2017; 11:125-137. [PMID: 29219627 DOI: 10.1080/17512433.2018.1412827] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Effective resuscitation with human albumin solutions is achieved with less fluid than with crystalloid solutions. However, the role of albumin in today's critical care unit is also linked to its multiple pharmacological effects. Areas covered: The potential clinical benefits of albumin in select populations of critically ill patients like sepsis seem related to immunomodulatory and anti-inflammatory effects, antibiotic transportation and endothelial stabilization. Albumin transports many drugs used in critically ill patients. Such binding to albumin is frequently lessened in critically ill patients with hypoalbuminemia. These changes could result in sub-optimal treatment. Albumin has immunomodulatory capacity by binding several bacterial products. Albumin also influences vascular integrity, contributing to the maintenance of the normal capillary permeability. Moreover, the albumin molecule encompasses several antioxidant properties, thereby significantly reducing re-oxygenation injury, which is especially important in sepsis. In fact, most studies of albumin administration are a combination of a degree of resuscitation with a degree of maintenance or supplementation of albumin. Expert commentary: The potential clinical benefits of the use of albumin in selected critically ill patients such as sepsis seem related to its immunomodulatory and anti-inflammatory effects, antioxidant properties, antibiotic transportation and endothelial stabilization. Additional studies are warranted to further elucidate the underlying physiologic and molecular rationale.
Collapse
Affiliation(s)
- Ricard Ferrer
- a Intensive Care Department , Vall d'Hebron University Hospital; Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d'Hebron Institut de Recerca , Barcelona , Spain
| | - Xavier Mateu
- b Pharmacy Department , Hospital del Mar , Barcelona , Spain
| | - Emilio Maseda
- c Anesthesiology and Resuscitation Department , La Paz University Hospital , Madrid , Spain
| | | | - César Aldecoa
- e Anesthesiology and Resuscitation Department , Río Hortega Hospital , Valladolid , Spain
| | | | - Juan Carlos Ruiz-Rodriguez
- a Intensive Care Department , Vall d'Hebron University Hospital; Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d'Hebron Institut de Recerca , Barcelona , Spain
| | - José Garnacho-Montero
- g Unidad Clínica de Cuidados Intensivos , Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS) , Sevilla , Spain
| |
Collapse
|
31
|
Zingg T, Bhattacharya B, Maerz LL. Metabolic acidosis and the role of unmeasured anions in critical illness and injury. J Surg Res 2017; 224:5-17. [PMID: 29506851 DOI: 10.1016/j.jss.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/04/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022]
Abstract
Acid-base disorders are frequently present in critically ill patients. Metabolic acidosis is associated with increased mortality, but it is unclear whether as a marker of the severity of the disease process or as a direct effector. The understanding of the metabolic component of acid-base derangements has evolved over time, and several theories and models for precise quantification and interpretation have been postulated during the last century. Unmeasured anions are the footprints of dissociated fixed acids and may be responsible for a significant component of metabolic acidosis. Their nature, origin, and prognostic value are incompletely understood. This review provides a historical overview of how the understanding of the metabolic component of acid-base disorders has evolved over time and describes the theoretical models and their corresponding tools applicable to clinical practice, with an emphasis on the role of unmeasured anions in general and several specific settings.
Collapse
Affiliation(s)
- Tobias Zingg
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut.
| | - Bishwajit Bhattacharya
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Linda L Maerz
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
32
|
Lactated Ringer Is Associated With Reduced Mortality and Less Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Analysis. Crit Care Med 2017; 44:2163-2170. [PMID: 27495820 DOI: 10.1097/ccm.0000000000001948] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. DESIGN Retrospective cohort. SETTING Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive Care-II). PATIENTS Adult patients with at least 2 days of ICU stay, admission creatinine lower than 5 mg/dL, and that received at least 500 mL of fluid in the first 48 hours. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS 10,249 patients were included in mortality analysis and 8,085 were included in the acute kidney injury analysis. For acute kidney injury analysis, we excluded patients achieving acute kidney injury criteria in the first 2 days of ICU stay. Acute kidney injury was defined as stage 2/3 Kidney Disease: Improving Global Outcomes creatinine criteria and was assessed from days 3-7. The effects of %LR in both outcomes were assessed through logistic regression controlling for confounders. Principal component analysis was applied to assess the effect of volume of each fluid type on mortality. Higher %LR was associated with lower mortality and less acute kidney injury. %LR effect increased with total volume of fluid infused. For patients in the fourth quartile of fluid volume (> 7 L), the odds ratio for mortality for %LR equal to 75% versus %LR equal to 25% was 0.50 (95% CI, 0.32-0.79; p < 0.001). Principal component analysis suggested that volume of Lactated Ringer and 0.9% saline infused had opposite effects in outcome, favoring Lactated Ringer. CONCLUSIONS Higher %LR was associated with reduced hospital mortality and with less acute kidney injury from days 3-7 after ICU admission. The association between %LR and mortality was influenced by the total volume of fluids infused.
Collapse
|
33
|
LASHEEN NN, MOHAMED GF. Possible Mechanisms of Cardiac Contractile Dysfunction and Electrical Changes in Ammonium Chloride Induced Chronic Metabolic Acidosis in Wistar Rats. Physiol Res 2016; 65:927-940. [DOI: 10.33549/physiolres.933171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Metabolic acidosis could occur due to either endogenous acids accumulation or bicarbonate loss from the gastrointestinal tract or commonly from the kidney. This study aimed to investigate the possible underlying mechanism(s) of chronic acidosis-induced cardiac contractile and electrical changes in rats. Twenty four adult Wistar rats, of both sexes, were randomly divided into control group and chronic metabolic acidosis group, which received orally 0.28 M NH4Cl in the drinking water for 2 weeks. At the end of experimental period, systolic and diastolic blood pressure values were measured. On the day of sacrifice, rats were anesthetized by i.p. pentobarbitone (40 mg/kg b.w.), transthoracic echocardiography and ECG were performed. Blood samples were obtained from abdominal aorta for complete blood count and determination of pH, bicarbonate, chloride, sodium, potassium, troponin I, CK-MB, IL-6, renin and aldosterone levels. Hearts from both groups were studied for cardiac tissue IL-6 and aldosterone in addition to histopathological examination. Compared to control group, chronic metabolic acidosis group showed anemia, significant systolic and diastolic hypotension accompanied by significant reduction of ejection fraction and fraction of shortening, significant bradycardia, prolonged QTc interval and higher widened T wave as well as significantly elevated plasma levels of renin, aldosterone, troponin I, CK-MB and IL-6, and cardiac tissue aldosterone and IL-6. The left ventricular wall of the acidosis group showed degenerated myocytes with fibrosis and apoptosis. Thus, chronic metabolic acidosis induced negative inotropic and chronotropic effects and cardiomyopathy, possibly by elevated aldosterone and IL-6 levels released from the cardiac tissue.
Collapse
Affiliation(s)
- N. N. LASHEEN
- Department of Physiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | |
Collapse
|
34
|
Ho KM, Lan NSH, Williams TA, Harahsheh Y, Chapman AR, Dobb GJ, Magder S. A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study. J Intensive Care 2016; 4:43. [PMID: 27366324 PMCID: PMC4928272 DOI: 10.1186/s40560-016-0166-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/21/2016] [Indexed: 12/11/2022] Open
Abstract
Background This cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill. Methods The relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission, and the hospital mortality of 6878 patients were analysed. The prognostic significance of each acid-base marker, both alone and in combination with the Admission Mortality Prediction Model (MPM0 III) predicted mortality, were assessed by the area under the receiver operating characteristic curve (AUROC). Results Of the 6878 patients included in the study, 924 patients (13.4 %) died after ICU admission. Except for plasma chloride concentrations, all acid-base markers were significantly different between the survivors and non-survivors. SIG (with lactate: AUROC 0.631, confidence interval [CI] 0.611–0.652; without lactate: AUROC 0.521, 95 % CI 0.500–0.542) only had a modest ability to predict hospital mortality, and this was no better than using lactate concentration alone (AUROC 0.701, 95 % 0.682–0.721). Adding AG-corrected or SIG to a combination of lactate and MPM0 III predicted risks also did not substantially improve the latter’s ability to differentiate between survivors and non-survivors. Arterial lactate concentrations explained about 11 % of the variability in the observed mortality, and it was more important than SIG (0.6 %) and SIDe (0.9 %) in predicting hospital mortality after adjusting for MPM0 III predicted risks. Lactate remained as the strongest predictor for mortality in a sensitivity multivariate analysis, allowing for non-linearity of all acid-base markers. Conclusions The prognostic significance of SIG was modest and inferior to arterial lactate concentration for the critically ill. Lactate concentration should always be considered regardless whether physiological, base excess or physical-chemical approach is used to interpret acid-base disturbances in critically ill patients.
Collapse
Affiliation(s)
- Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000 Australia ; School of Population Health, University of Western Australia, Perth, Australia ; School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Norris S H Lan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Teresa A Williams
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Yusra Harahsheh
- Department of Intensive Care Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000 Australia
| | - Andrew R Chapman
- Department of Intensive Care Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000 Australia
| | - Geoffrey J Dobb
- Department of Intensive Care Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000 Australia ; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Sheldon Magder
- Critical Care Division, Department of Medicine and Physiology, Royal Victoria Hospital, McGill University Health Centre and McGill University, Montréal, Canada
| |
Collapse
|
35
|
Influence of Body Mass Index on Inflammatory Profile at Admission in Critically Ill Septic Patients. Int J Inflam 2015; 2015:734857. [PMID: 26064774 PMCID: PMC4441988 DOI: 10.1155/2015/734857] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/12/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction. Inflammation is ubiquitous during sepsis and may be influenced by body mass index (BMI). We sought to evaluate if BMI was associated with serum levels of several cytokines measured at intensive care unit admission due to sepsis. Methods. 33 septic patients were included. An array of thirty-two cytokines and chemokines was measured using Milliplex technology. We assessed the association between cytokine levels and BMI by generalized additive model that also included illness severity (measured by SAPS 3 score); one model was built for each cytokine measured. Results. We found that levels of epidermal growth factor, vascular endothelial growth factor, and interleukins 4, 5, and 13 were associated with BMI in a complex, nonlinear way, independently of illness severity. Higher BMI was associated with higher levels of anti-inflammatory interleukins. Conclusion. BMI may influence host response to infection during critical illness. Larger studies should confirm these findings.
Collapse
|
36
|
Marano M. Relationship between reduced albumin and inflammation in the critically ill. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:177. [PMID: 25928874 PMCID: PMC4403944 DOI: 10.1186/s13054-015-0746-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marco Marano
- Hemodialysis Unit, Maria Rosaria Clinic, via Colle San Bartolomeo, 50, Pompeii, 80045, Italy.
| |
Collapse
|
37
|
Redox Changes Induced by General Anesthesia in Critically Ill Patients with Multiple Traumas. Mol Biol Int 2015; 2015:238586. [PMID: 26693352 PMCID: PMC4674615 DOI: 10.1155/2015/238586] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/15/2015] [Indexed: 01/07/2023] Open
Abstract
The critically ill polytrauma patient is a constant challenge for the trauma team due to the complexity of the complications presented. Intense inflammatory response and infections, as well as multiple organ dysfunctions, significantly increase the rate of morbidity and mortality in these patients. Moreover, due to the physiological and biochemical imbalances present in this type of patients, the bioproduction of free radicals is significantly accelerated, thus installing the oxidative stress. In the therapeutic management of such patients, multiple surgical interventions are required and therefore they are being subjected to repeated general anesthesia. In this paper, we want to present the pathophysiological implications of oxidative stress in critically ill patients with multiple traumas and the implications of general anesthesia on the redox mechanisms of the cell. We also want to summarize the antioxidant treatments able to reduce the intensity of oxidative stress by modulating the biochemical activity of some cellular mechanisms.
Collapse
|
38
|
Abstract
Zampieri and colleagues used sophisticated statistical methods to create a picture of acid-base pattern and inflammation relationship in a clinical context. The observed independent relationship between acidosis and albumin concentration and inflammatory pattern opens up a new area for research. It has become clear that, in addition to the characterization of mediators, receptors, and cellular phenotypes, the inflammatory response has to be interpreted in light of acid-base status, albumin concentration, and probably also carbon dioxide level.
Collapse
|