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Panova IG, Tatikolov AS. Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy). Pharmaceuticals (Basel) 2023; 16:1077. [PMID: 37630992 PMCID: PMC10458090 DOI: 10.3390/ph16081077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
The use of conventional contrast media for diagnostic purposes (in particular, Gd-containing and iodinated agents) causes a large number of complications, the most common of which is contrast-induced nephropathy. It has been shown that after exposure to contrast agents, oxidative stress often occurs in patients, especially in people suffering from various diseases. Antioxidants in the human body can diminish the pathological consequences of the use of contrast media by suppressing oxidative stress. This review considers the research studies on the role of antioxidants in preventing the negative consequences of the use of contrast agents in diagnostics (mainly contrast-induced nephropathy) and the clinical trials of different antioxidant drugs against contrast-induced nephropathy. Composite antioxidant/contrast systems as theranostic agents are also considered.
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Affiliation(s)
- Ina G. Panova
- International Scientific and Practical Center of Tissue Proliferation, 29/14 Prechistenka Str., 119034 Moscow, Russia;
| | - Alexander S. Tatikolov
- N.M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 4 Kosygin Str., 119334 Moscow, Russia
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Predictive and Prognostic Value of Serum Neutrophil Gelatinase-Associated Lipocalin for Contrast-Induced Acute Kidney Injury and Long-Term Clinical Outcomes after Percutaneous Coronary Intervention. J Clin Med 2022; 11:jcm11195971. [PMID: 36233836 PMCID: PMC9573626 DOI: 10.3390/jcm11195971] [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: 09/17/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) has been proposed as an early marker for estimating the risk of contrast-induced acute kidney injury (CI-AKI). However, the predictive value of baseline serum NGAL levels for CI-AKI remains unclear. Serum NGAL was measured before percutaneous coronary intervention in 633 patients with coronary artery disease. The primary clinical endpoints were a composite of major adverse cardiac and cerebrovascular events (MACCEs; cardiac death, myocardial infarction, stroke, and any revascularization). The mean follow-up duration was 29.4 months. Ninety-eight (15.5%) patients developed CI-AKI. Compared with patients without CI-AKI, baseline serum NGAL was higher in patients with CI-AKI (149.6 ± 88.8 ng/mL vs. 138.0 ± 98.6 ng/mL, p = 0.0279), although serum creatinine and estimated glomerular filtration rate were not different between groups. Patients in the highest tertile of baseline serum NGAL showed a significantly higher rate of MACCEs (10.5% vs. 3.8%, p = 0.02). Using the first tertile as a reference, the adjusted hazard ratios for MACCEs in patients in the second and third tertiles of NGAL were 2.151 (confidence interval (CI) 0.82 to 5.59, p = 0.116) and 2.725 (CI 1.05 to 7.05, p = 0.039), respectively. Baseline serum NGAL is a reliable marker for predicting CI-AKI, and high serum NGAL levels are associated with a higher incidence rate of long term MACCEs.
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Abstract
PURPOSE OF REVIEW The scope of procedures conducted by neurointerventionalists is expanding quickly, with lacking consensus over the best anesthesia modality. Although the procedures involve all age groups, the interventions may be complex and lengthy and may be provided in hospitals currently not yet familiar with the field. Here we review current literature addressing elective outpatient neurointerventional procedures and aim to provide an update on the management of intervention-specific crises, address special patient populations, and provide key learning points for everyday use in the neurointerventional radiology suite. RECENT FINDINGS Various studies have compared the use of different anesthesia modalities and preinterventional and postinterventional care. Monitored anesthesia care is generally recommended for elderly patients, whereas children are preferably treated with general anesthesia. Additional local anesthesia is beneficial for procedures, such as percutaneous kyphoplasty and vascular access. SUMMARY Combining different anesthetic modalities is a valuable approach in the neurointerventional radiology suite. More interventional and patient population-specific studies are needed to improve evidence-based perioperative management.
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Tao Q, Zhang D, Zhang Q, Liu C, Ye S, Feng Y, Liu R. Mitochondrial targeted ROS Scavenger based on nitroxide for Treatment and MRI imaging of Acute Kidney Injury. Free Radic Res 2022; 56:303-315. [PMID: 35746859 DOI: 10.1080/10715762.2022.2093724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Overproduction of reactive oxygen species (ROS) during oxidative stress is a hallmark of acute kidney injure (AKI), which induced the damage to the renal cells and mitochondrial injury. PURPOSE In this contribution, we prepared mitochondrial targeted nitroxide, which linked 3-carboxy-2,2,5,5-tetramethylpyrrolidine 1-oxyl (carboxy-PROXYL) with (2-aminoethyl)triphenylphosphonium bromide (TPP), named TPP-PROXYL to eliminate the ROS in situ and image the oxidative stress reaction by MRI. METHODS 2,7-Dichlorodihydrofluorescein diacetate (DCFH-DA) staining, mitochondrial membrane potential assay (JC-1) staining and transmission electron microscope (TEM) experiments were processed to verify that TPP-PROXYL could target mitochondria, scavenge the ROS, and prevent damage to mitochondria in live cells. Contrast enhanced MRI also been used to monitor these redox reaction in AKI model. RESULTS TPP-PROXYL demonstrated excellent ROS T1-weighted magnetic resonance imaging (MRI) enhancement in vitro and in vivo, with r1 value about 0.190 mM-1·s-1. In vivo AKI treatment experiments proved that TPP-PROXYL could improve the survival rate of mice and inhibit kidney damage. Moreover, the great ROS scavenging capability and the renal damage reduction during AKI treatment of TPP-PROXYL was verified via MR imaging technology. CONCLUSION Collectively, this research provides TPP-PROXYL would serve as a powerful platform to realize ROS scavenging, treatment and MR imaging of AKI.
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Affiliation(s)
- Quan Tao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Di Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Qianqian Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Chuang Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Sheng Ye
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Ruiyuan Liu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.,Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China.,Key Laboratory of Mental Health of the Ministry of Education & Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
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Abstract
Contrast agents have become an indispensable part of everyday life in diagnostic radiology. In multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), they provide essential diagnostic information, especially for vascular, inflammatory or oncologic diseases, which otherwise could not be answered. The two most important groups are iodine- and gadolinium-containing contrast agents. Rare side effects include PC-AKI (post-contrast acute kidney injury); more common are allergic and chemotoxic reactions. Since the introduction of guidelines, nephrogenic fibrosis has not been reported anymore, whereas gadolinium deposition in the central nervous system (CNS) has become a new topic. Concerning contrast media use in patients with reduced renal function, at a eGFR threshold of <45 ml/min or <30 ml/min, hydration and a review of indication for enhanced MDCT, depending on the application, is recommended. Low kV and DE-scan protocols with MDCT can help to reduce the amount of iodinated contrast agents. In MRI examinations, only macrocyclic contrast agents should be used for enhanced MRI exams. There has to be a careful risk-benefit analysis with enhanced studies in pregnancy, during lactation and in the pediatric population. Patient information and legal aspects with nonapproved indications are indispensable parts of daily clinical routine. The continuous updating and broadening of knowledge regarding the appropriate use of the various contrast agents has to be an integral part of clinical diagnostic radiology.
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Affiliation(s)
- Christian Krestan
- Abteilung für Allgemeine- und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Lederer W, Grams A, Helbok R, Stichlberger M, Bale R, Wiedermann FJ. Standards of anesthesiology practice during neuroradiological interventions. Open Med (Wars) 2016; 11:270-278. [PMID: 28352807 PMCID: PMC5329840 DOI: 10.1515/med-2016-0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/29/2016] [Indexed: 11/15/2022] Open
Abstract
Interventional radiology is a rapidly growing discipline with an expanding variety of indications and techniques in pediatric and adult patients. Accordingly, the number of procedures during which monitoring either under sedation or under general anesthesia is needed is increasing. In order to ensure high-quality care as well as patient comfort and safety, implementation of anes-thesiology practice guidelines in line with institutional radiology practice guidelines is paramount [1]. However, practice guidelines are no substitute for lack of communi-cation between specialties. Interdisciplinary indications within neurosciences call for efficient co-operation among radiology, neurology, neurosurgery, vascular surgery, anesthesiology and intensive care. Anesthesia team and intensive care personnel should be informed early and be involved in coordinated planning so that optimal results can be achieved under minimized risks and pre-arranged complication management.
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Affiliation(s)
- Wolfgang Lederer
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Martina Stichlberger
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria, Tel. +43 512 504 80431
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Franz J. Wiedermann
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria, Tel. +43 512 504 80431
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Karathanos TV, Boyle PM, Trayanova NA. Optogenetics-enabled dynamic modulation of action potential duration in atrial tissue: feasibility of a novel therapeutic approach. Europace 2015; 16 Suppl 4:iv69-iv76. [PMID: 25362173 DOI: 10.1093/europace/euu250] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Diseases that abbreviate the cardiac action potential (AP) by increasing the strength of repolarizing transmembrane currents are highly arrhythmogenic. It has been proposed that optogenetic tools could be used to restore normal AP duration (APD) in the heart under such disease conditions. This study aims to evaluate the efficacy of an optogenetic treatment modality for prolonging pathologically shortened APs in a detailed computational model of short QT syndrome (SQTS) in the human atria, and compare it to drug treatment. METHODS AND RESULTS We used a human atrial myocyte model with faster repolarization caused by SQTS; light sensitivity was inscribed via the presence of channelrhodopsin-2 (ChR2). We conducted simulations in single cells and in a magnetic resonance imaging-based model of the human left atrium (LA). Application of an appropriate optical stimulus to a diseased cell dynamically increased APD, producing an excellent match to control AP (<1.5 mV deviation); treatment of a diseased cell with an AP-prolonging drug (chloroquine) also increased APD, but the match to control AP was worse (>5 mV deviation). Under idealized conditions in the LA (uniform ChR2-expressing cell distribution, no light attenuation), optogenetics-based therapy outperformed chloroquine treatment (APD increased to 87% and 81% of control). However, when non-uniform ChR2-expressing cell distribution and light attenuation were incorporated, optogenetics-based treatment was less effective (APD only increased to 55%). CONCLUSION This study demonstrates proof of concept for optogenetics-based treatment of diseases that alter atrial AP shape. We identified key practical obstacles intrinsic to the optogenetic approach that must be overcome before such treatments can be realized.
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Affiliation(s)
- Thomas V Karathanos
- Department of Biomedical Engineering, Institute for Computational Medicine and Johns Hopkins University, 3400 N. Charles St., Hackerman Hall Room 316, Baltimore, MD 21218, USA
| | - Patrick M Boyle
- Department of Biomedical Engineering, Institute for Computational Medicine and Johns Hopkins University, 3400 N. Charles St., Hackerman Hall Room 316, Baltimore, MD 21218, USA
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Institute for Computational Medicine and Johns Hopkins University, 3400 N. Charles St., Hackerman Hall Room 316, Baltimore, MD 21218, USA
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Gao L, Hu X, Liu YQ, Xue Q, Feng QZ. Percutaneous coronary intervention in the elderly with ST-segment elevation myocardial infarction. Clin Interv Aging 2014; 9:1241-6. [PMID: 25114518 PMCID: PMC4124048 DOI: 10.2147/cia.s62642] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
As a result of increased life expectancy, octogenarians constitute an increasing proportion of patients admitted to hospital for ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention is currently the treatment of choice for octogenarians presenting with STEMI. The recent literature on this topic has yielded controversial results, even though advances in drug-eluting stents and new types of antithrombotic agents are improving the management of STEMI and postoperative care. In this paper, we review the current status of percutaneous coronary intervention in the elderly with STEMI, including the reasons for their high mortality and morbidity, predictors of mortality, and strategies to improve outcomes.
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Affiliation(s)
- Lei Gao
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Xin Hu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yu-Qi Liu
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qiao Xue
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Quan-Zhou Feng
- Institute of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People’s Republic of China
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