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Wu Z, Jiang H, Yin Q, Zhang Z, Chen X. Arginine vasopressin induces ferroptosis to promote heart failure via activation of the V1aR/CaN/NFATC3 pathway. Acta Biochim Biophys Sin (Shanghai) 2024; 56:474-481. [PMID: 38247327 DOI: 10.3724/abbs.2023289] [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] [Indexed: 01/23/2024] Open
Abstract
Arginine vasopressin (AVP) is a key contributor to heart failure (HF), but the underlying mechanisms remain unclear. In the present study, a mouse model of HF and human cardiomyocyte (HCM) cells treated with dDAVP are generated in vivo and in vitro, respectively. Hematoxylin and eosin (HE) staining is used to evaluate the morphological changes in the myocardial tissues. A colorimetric method is used to measure the iron concentration, Fe 2+ concentration and malondialdehyde (MDA) level. Western blot analysis is used to examine the protein levels of the V1a receptor (V1aR), calcineurin (CaN), nuclear factor of activated T cells isoform C3 (NFATC3), glutathione peroxidase 4 (GPX4) and acyl-CoA synthase long chain family member 4 (ACSL4). Immunoprecipitation (IP) and luciferase reporter assays are performed to determine the interaction between NFATC3 and ACSL4. Both in vivo and in vitro experiments reveal that the V1aR-CaN-NFATC3 signaling pathway and ferroptosis are upregulated in HFs, which are verified by the elevated protein levels of V1aR, CaN, NFATC3 and ACSL4; reduced GPX4 protein level; and enhanced Fe 2+ and MDA levels. We further find that inhibiting NFATC3 by suppressing the V1aR/CaN/NFATC3 pathway via V1aR/CaN inhibitors or sh-NFATC3 not only alleviates HF but also inhibits AVP-induced ferroptosis. Mechanistically, sh-NFATC3 significantly reverses the increase in AVP-induced ACSL4 protein level, Fe 2+ concentration, and MDA level by directly interacting with ACSL4. Our results demonstrate that AVP enhances ACSL4 expression by activating the V1aR/CaN/NFATC3 pathway to induce ferroptosis, thus contributing to HF. This study may lead to the proposal of a novel therapeutic strategy for HF.
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Affiliation(s)
- Zhiyong Wu
- Department of Cardiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Hua Jiang
- Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan 430022, China
| | - Qiulin Yin
- Department of Cardiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Zhifeng Zhang
- Department of Cardiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Xuanlan Chen
- Department of Cardiology, Jiangxi Provincial People's Hospital, the First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
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García-Álvarez R, Arboleda-Salazar R. Vasopressin in Sepsis and Other Shock States: State of the Art. J Pers Med 2023; 13:1548. [PMID: 38003863 PMCID: PMC10672256 DOI: 10.3390/jpm13111548] [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: 09/03/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
This review of the use of vasopressin aims to be comprehensive and highly practical, based on the available scientific evidence and our extensive clinical experience with the drug. It summarizes controversies about vasopressin use in septic shock and other vasodilatory states. Vasopressin is a natural hormone with powerful vasoconstrictive effects and is responsible for the regulation of plasma osmolality by maintaining fluid homeostasis. Septic shock is defined by the need for vasopressors to correct hypotension and lactic acidosis secondary to infection, with a high mortality rate. The Surviving Sepsis Campaign guidelines recommend vasopressin as a second-line vasopressor, added to norepinephrine. However, these guidelines do not address specific debates surrounding the use of vasopressin in real-world clinical practice.
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Affiliation(s)
- Raquel García-Álvarez
- Department of Anesthesiology and Surgical Intensive Care, University Hospital 12 de Octubre, 28022 Madrid, Spain
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3
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Rives JP, Millet C, Sciaraffa C, Demiri M. Perioperative polyuria associated with dexmedetomidine administration during reconstruction breast surgery. Anaesth Crit Care Pain Med 2023; 42:101290. [PMID: 37567413 DOI: 10.1016/j.accpm.2023.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 08/13/2023]
Affiliation(s)
| | - Clément Millet
- Department of Anesthesia, Gustave Roussy Cancer Center, Villejuif, France
| | - Cédric Sciaraffa
- Department of Anesthesia, Gustave Roussy Cancer Center, Villejuif, France
| | - Migena Demiri
- Department of Anesthesia, Gustave Roussy Cancer Center, Villejuif, France.
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Davis DP, Olvera D, Selde W, Wilmas J, Stuhlmiller D. Bolus Vasopressor Use for Air Medical Rapid Sequence Intubation: The Vasopressor Intravenous Push to Enhance Resuscitation Trial. Air Med J 2023; 42:36-41. [PMID: 36710033 DOI: 10.1016/j.amj.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Rapid sequence intubation (RSI) may compromise perfusion because of the use of sympatholytic medications as well as subsequent positive pressure ventilation. The use of bolus vasopressor agents may reverse hypotension and prevent arrest. METHODS This was a prospective, observational study enrolling air medical patients with critical peri-RSI hypotension (systolic blood pressure [SBP] < 90 mm Hg) to receive either arginine vasopressin (aVP), 2 U intravenously every 5 minutes, for trauma patients or phenylephrine (PE), 200 μg intravenously every 5 minutes, for nontrauma patients. The main outcome measures included an increase in SBP, a reversal of hypotension, and the occurrence of dysrhythmia or hypertension (SBP > 160 mm Hg) within 20 minutes of vasopressor administration. RESULTS A total of 523 patients (344 aVP and 179 PE) were enrolled over 2 years. An increase in SBP was observed in 326 aVP patients (95%), with reversal of hypotension in 272 patients (79%). An increase in SBP was observed in 171 PE patients (96%), with reversal of hypotension in 148 patients (83%). A low rate of rebound hypertension was observed for both aVP and PE patients. CONCLUSION Both aVP and PE appear to be safe and effective for treating critical hypotension in the peri-RSI period.
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Affiliation(s)
| | | | | | - John Wilmas
- Air Methods Corporation, Greenwood Village, CO
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Liu X, Cao H, Tan X, Shi J, Qiao L, Zhang Q, Shi L. The effect of acetate Ringer's solution versus lactate Ringer's solution on acid base physiology in infants with biliary atresia. BMC Pediatr 2021; 21:585. [PMID: 34930212 PMCID: PMC8686578 DOI: 10.1186/s12887-021-03074-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The choice of the perioperative crystalloid is a key component of the fluid management and must take into account the liver function and the appearing metabolic disorders to avoid increase the liver extra metabolism. The aim of this study is to analyze the effect of acetate Ringer's solution or lactate Ringer's solution in biliary atresia patients. METHODS We included 68 infant patients aged between 21 ~ 65 d, ASA physical status II or III, who underwent elective Kasai hepatoportoenterostomy, received either AR and LR for intravenous fluid resuscitation according to their group allocation. Lactate concentration, serum electrolytes and pH were noteded before skin incision (T1), end of surgery (T2) and postoperative 12 h. We also recorded the time of operation, stay of hospital, loss of blood and urinary, total volume of infusion of crystalloid. RESULTS Lactate level was significantly higher in Group LR than in Group AR patients at T2 (0.76 ± 0.13 versus 0.57 ± 0.22, P = 0.03). Compared with T3, sodium and chlorine were significantly higher in two groups at T2 (145.2 ± 3.1 versus 143.4 ± 3.4 and 104.6 ± 3.7 versus 105.2 ± 2.1). No significant differences were noted in potassium, HCO3- and calcium. There was no statistically significant difference in pH. No glycopenia was recorded in two groups. No significant difference was noted in administration of vasoactive drug (0.7% versus 1%). CONCLUSIONS Resuscitation with AR and LR was associated with similar clinical improvement in infants with biliary atresia. Use of AR reduced the level of lactate comparison with LR.
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Affiliation(s)
- Xiang Liu
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Hongyan Cao
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Xiaona Tan
- Department of Neurological Rehabilitation, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Jing Shi
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Li Qiao
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Qi Zhang
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China
| | - Lei Shi
- Department of Operating Room and Anesthesiology, The children's hospital of hebei province, No. 133 Jian Hua South Road, Shi Jiazhuang, 050030, China.
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Soliman R, Yacoub A, Elbiaa AAM. Assessment of the perioperative effect of vasopressin in patients undergoing laparoscopic myomectomy: A double-blind randomised study. Indian J Anaesth 2021; 65:139-145. [PMID: 33776089 PMCID: PMC7983821 DOI: 10.4103/ija.ija_363_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Myomectomy is associated with perioperative bleeding. The aim of the study is to evaluate the effect of intramyometrial vasopressin on blood loss and the associated cardiovascular complications during myomectomy. Methods: The study included 194 patients classified into two groups- 1) Vasopressin group: the vasopressin was diluted as 0.1 unit/ml and 15 ml was injected by the surgeon in the plane between the myometrium and the myoma. 2) Control group: The patients received an equal amount of normal saline. The monitored parameters included the amount of blood loss, required blood transfusion, heart rate, mean arterial blood pressure, the incidence of hypertension, hypotension, bradycardia, tachycardia, electrocardiogram (ECG) changes and the blood troponin I level. Results: The heart rate decreased significantly in both groups, but the decrease was lower with vasopressin than the control group through the time points T3 to T5 (P < 0.05) The mean arterial blood pressure increased significantly in both groups, but the increase was higher with vasopressin than the control group through T3 to T5 (P < 0.05). The amount of blood loss decreased significantly with vasopressin than the control groups (P = 0.001). The number of transfused packed red blood cells was lower with vasopressin than the control group (P = 0.001). The incidence of hypertension, bradycardia and atrial extrasystole was higher with vasopressin than the control group (P = 0.005, P = 0.012, P = 0.033, respectively). Conclusion: Intramyometrial vasopressin decreases blood loss and blood transfusion, but it is associated with cardiovascular complications that may be serious as reported in other studies. Therefore, anaesthesiologists and gynaecologists must follow the precautions to avoid and minimise the incidence of complications with intramyometrial vasopressin.
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Affiliation(s)
| | - Abdelbadee Yacoub
- Department of Anaesthesia, Faculty of Medicine, Al Azhar University, Egypt
| | - Assem A M Elbiaa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ein Shams University, Egypt
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Chandrasekharan R, Shree I. Concerns with intramyometrial vasopressin as a hemostatic agent. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_232_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim JW, Kim G, Kim TW, Han W, Kim MS, Jeong CY, Park DH. Hemodynamic changes following accidental infiltration of a high dose of vasopressin. J Int Med Res 2020; 48:300060520959494. [PMID: 32993389 PMCID: PMC7536500 DOI: 10.1177/0300060520959494] [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: 11/16/2022] Open
Abstract
Vasopressin local infiltration is useful in gynecological surgery because it can reduce
hemorrhage. Depending on the activities of the sympathetic system and the
renin–angiotensin system, reactions to vasopressin may differ and predicting its systemic
effects is difficult. Because life-threatening complications can occur, infiltration with
vasopressin should be administered with caution. A 42-year-old female patient was
diagnosed with uterine leiomyomas. During a robot-assisted laparoscopic myomectomy, 50 U
of vasopressin, which is ten-times the recommended dose, was accidentally infiltrated.
Subsequently, bradycardia with a heart rate of 25 bpm occurred, which recovered within 3
minutes. Peripheral perfusion indices and the diameter of the radial and brachial arteries
also decreased markedly and recovered within 1 hour. The surgery was concluded without
additional events. The patient was discharged 2 days later with no abnormal findings.
Because vasopressin infiltration can cause life-threatening complications, it is necessary
to determine the extent of patient reactions to vasopressin using measures such as the
peripheral perfusion index or radial and brachial artery diameters. These measures may
also help to predict the occurrence of complications.
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Affiliation(s)
- Jae Won Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Goo Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Tae Woo Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Woong Han
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Mo Se Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Chang Young Jeong
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Dong Ho Park
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
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Protein misfolding in endoplasmic reticulum stress with applications to renal diseases. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2020. [PMID: 31928726 DOI: 10.1016/bs.apcsb.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Protein misfolding may be the result of a variety of different processes that disrupt the ability of a protein to form a thermodynamically stable tertiary structure that allows it to perform its proper function. In this chapter, we explore the nature of a protein's form that allows it to have a stable tertiary structure, and examine specific mutation that are known to occur in the coding regions of DNA that disrupt a protein's ability to be folded into a thermodynamically stable tertiary structure. We examine the consequences of these protein misfoldings in terms of the endoplasmic reticulum stress response and resulting unfolded protein response. These conditions are specifically related to renal diseases. Further, we explore novel therapeutics, pharmacological chaperones, that are being developed to alleviate the disease burden associated with protein misfolding caused by mutations. These interventions aim to stabilize protein folding intermediates and allow proper folding to occur as well as prevent protein aggregation and the resulting pathophysiological consequences.
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Samy A, Raslan AN, Talaat B, El Lithy A, El Sharkawy M, Sharaf MF, Hussein AH, Amin AH, Ibrahim AM, Elsherbiny WS, Soliman HH, Metwally AA. Perioperative nonhormonal pharmacological interventions for bleeding reduction during open and minimally invasive myomectomy: a systematic review and network meta-analysis. Fertil Steril 2020; 113:224-233.e6. [DOI: 10.1016/j.fertnstert.2019.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 09/02/2019] [Accepted: 09/13/2019] [Indexed: 01/21/2023]
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Kanbay M, Yilmaz S, Dincer N, Ortiz A, Sag AA, Covic A, Sánchez-Lozada LG, Lanaspa MA, Cherney DZI, Johnson RJ, Afsar B. Antidiuretic Hormone and Serum Osmolarity Physiology and Related Outcomes: What Is Old, What Is New, and What Is Unknown? J Clin Endocrinol Metab 2019; 104:5406-5420. [PMID: 31365096 DOI: 10.1210/jc.2019-01049] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/25/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Although the physiology of sodium, water, and arginine vasopressin (AVP), also known as antidiuretic hormone, has long been known, accumulating data suggest that this system operates as a more complex network than previously thought. EVIDENCE ACQUISITION English-language basic science and clinical studies of AVP and osmolarity on the development of kidney and cardiovascular disease and overall outcomes. EVIDENCE SYNTHESIS Apart from osmoreceptors and hypovolemia, AVP secretion is modified by novel factors such as tongue acid-sensing taste receptor cells and brain median preoptic nucleus neurons. Moreover, pharyngeal, esophageal, and/or gastric sensors and gut microbiota modulate AVP secretion. Evidence is accumulating that increased osmolarity, AVP, copeptin, and dehydration are all associated with worse outcomes in chronic disease states such as chronic kidney disease (CKD), diabetes, and heart failure. On the basis of these pathophysiological relationships, an AVP receptor 2 blocker is now licensed for CKD related to polycystic kidney disease. CONCLUSION From a therapeutic perspective, fluid intake may be associated with increased AVP secretion if it is driven by loss of urine concentration capacity or with suppressed AVP if it is driven by voluntary fluid intake. In the current review, we summarize the literature on the relationship between elevated osmolarity, AVP, copeptin, and dehydration with renal and cardiovascular outcomes and underlying classical and novel pathophysiologic pathways. We also review recent unexpected and contrasting findings regarding AVP physiology in an attempt to explain and understand some of these relationships.
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Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sezen Yilmaz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Neris Dincer
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C. I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laura G Sánchez-Lozada
- Laboratory of Renal Physiopathology, Department of Nephrology, INC Ignacio Chávez, Mexico City, Mexico
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, Colorado
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Baris Afsar
- Division of Nephrology, Department of Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
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Dumps C, Umrath V. 58/m mit Sepsis nach Perforation eines Sigmadivertikels. Anaesthesist 2019; 68:284-287. [DOI: 10.1007/s00101-019-00662-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kagerbauer SM, Martin J, Ulm B, Jungwirth B, Podtschaske AH. Influence of perioperative stress on central and peripheral oxytocin and arginine-vasopressin concentrations. J Neuroendocrinol 2019; 31:e12797. [PMID: 31538678 DOI: 10.1111/jne.12797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/27/2022]
Abstract
Perioperative stress provides not only physical, but also psychic and emotional aspects, which may influence the hypothalamic neuropeptide system. Studies investigating the perioperative course of central neuropeptide activity are missing. Therefore, the present study aimed to determine perioperative fluctuations in central and concomitant peripheral concentrations of the hypothalamic neuropeptides oxytocin (OXT) and arginine-vasopressin (AVP), as well as their impact on perioperative anxiety and depression. Cerebrospinal fluid (CSF), blood and saliva were collected from 12 patients who underwent elective endovascular aortic repair with a routinely inserted spinal catheter. AVP and OXT concentrations were analysed at four timepoints: (i) the evening before the operation; (ii) the operation day immediately before anaesthesia induction; (iii) intraoperatively after the stent was placed; and (iv) on day 1 after the operation. Patients completed the Hospital Anxiety and Depression Scale (HADS) at timepoints 1 and 4. For CSF OXT, the present study showed a significant intraoperative decline, accompanied by a decrease in saliva. OXT blood concentrations before anaesthesia induction were higher than at the evening before the operation. OXT concentrations in CSF and saliva correlated well at timepoints 2-4. AVP concentrations in CSF, blood and saliva did not show any significant changes perioperatively. However, postoperative AVP blood concentrations showed a significant negative correlation with anxiety and depression scores according to the HADS. This pilot study demonstrates perioperative fluctuations in central OXT concentrations, which are better reflected by saliva than by blood. Further studies are required to determine whether OXT and AVP can predict postoperative post-traumatic stress disorder.
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Affiliation(s)
- Simone Maria Kagerbauer
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan Martin
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Ulm
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Armin Horst Podtschaske
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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Shimauchi T, Maki J, Yoshino J, Fujimura N, Hoka S. Effectiveness of arginine vasopressin for the management of refractory hemorrhagic shock in a patient with autonomic dysreflexia caused by spinal cord injury. JA Clin Rep 2018; 4:79. [PMID: 32026013 PMCID: PMC6966762 DOI: 10.1186/s40981-018-0216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/01/2018] [Indexed: 11/18/2022] Open
Abstract
Background Arginine vasopressin has been used for the management of refractory vasodilatory shock. However, it is still unclear whether arginine vasopressin is useful for hypotension in patients with spinal cord injury. Case description A 78-year-old man with autonomic dysreflexia and paralysis below the level corresponding to Th2 due to spinal cord injury previously underwent cholecystectomy. During the surgery, accidental hemorrhage led him to refractory hemorrhagic shock unresponsive to fluid resuscitation and catecholamine. Lasting hypotension was improved with arginine vasopressin. Conclusion We described a rare case report on the use of arginine vasopressin for management of refractory hemorrhagic shock in a patient with autonomic dysreflexia.
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Affiliation(s)
- Tsukasa Shimauchi
- Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Jun Maki
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Jun Yoshino
- Department of Anesthesiology, St Mary's Hospital, Kurume, Japan
| | | | - Sumio Hoka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Lee GG, Baek SY, Woo Kim T, Jeong CY, Ryu KH, Park DH. Cardiac arrest caused by intramyometrial injection of vasopressin during a robotic-assisted laparoscopic myomectomy. J Int Med Res 2018; 46:5303-5308. [PMID: 30345858 PMCID: PMC6300950 DOI: 10.1177/0300060518805596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Vasopressin is a locally-injected vasoconstrictor used to reduce bleeding during gynaecological surgery. However, even in these cases, vasopressin can induce adverse effects, including bradycardia, myocardial infarction and cardiac arrest. Elevated blood concentrations of vasopressin may induce the sympathoinhibitory reflex by increasing blood pressure and augment the sympathoinhibitory reflex by activating the area postrema. In addition, pneumoperitoneum formation needed for laparoscopy as well as physiological changes caused by steep Trendelenburg positions used during robotic surgeries may cause bradycardia. Shoulder braces used to prevent slipping from a steep Trendelenburg position may also be hazardous. This case report describes a 31-year-old female patient who underwent a scheduled robotic-assisted laparoscopic myomectomy in a steep Trendelenburg position. The patient experienced a cardiac arrest 2 min after the vasopressin injection and was treated accordingly. There were no abnormal findings on the postoperative laboratory studies, chest X-ray and electrocardiogram. The patient also had clear consciousness with no other notable symptoms. The patient was discharged on postoperative day 2. The report discusses the potential adverse effects of local vasopressin injection during robotic-assisted laparoscopic myomectomy.
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Affiliation(s)
- Gang Geun Lee
- Department of Anaesthesiology and Pain Medicine, Eulji University Medical Centre, Daejeon, Republic of Korea
| | - Seung Youp Baek
- Department of Anaesthesiology and Pain Medicine, Eulji University Medical Centre, Daejeon, Republic of Korea
| | - Tae Woo Kim
- Department of Anaesthesiology and Pain Medicine, Eulji University Medical Centre, Daejeon, Republic of Korea
| | - Chang Young Jeong
- Department of Anaesthesiology and Pain Medicine, Eulji University Medical Centre, Daejeon, Republic of Korea
| | - Keon Hee Ryu
- Department of Anaesthesiology and Pain Medicine, Eulji University Medical Centre, Daejeon, Republic of Korea
| | - Dong Ho Park
- Department of Anaesthesiology and Pain Medicine, Eulji University Medical Centre, Daejeon, Republic of Korea
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Ma Y, Liu X, Shen Y. Effect of traditional Chinese and Western medicine on nocturnal enuresis in children and indicators of treatment success: Randomized controlled trial. Pediatr Int 2017; 59:1183-1188. [PMID: 28891253 DOI: 10.1111/ped.13417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/02/2017] [Accepted: 09/05/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nocturnal enuresis (NE) is a common pediatric developmental disorder. Desmopressin is frequently used for NE and is an evidence-based therapy. Suoquan capsule is a Chinese medicine commonly used for treating NE in children but is poorly understood by most scholars. METHODS A total of 369 children with NE were randomized to receive either suoquan, desmopressin plus suoquan, desmopressin, or behavioral intervention for 2 months, and the response rates evaluated. Subsequently, the viable demographic factors that could lead to success were investigated on logistic regression analysis. Moreover, after 3 months of follow up, the relapse rate was investigated. RESULTS The complete response (CR) rate in the desmopressin plus suoquan group (37.5%) was higher than that in the behavioral intervention group (6.3%, P < 0.007). The desmopressin group had a lower CR rate (22.5%) and a higher non-response rate (25.0%) than the desmopressin plus suoquan group (non-response rate, 21.9%; P > 0.007). The relapse rate in the desmopressin group was significantly higher than that in the desmopressin plus suoquan group (72.2% vs. 30.6%, P < 0.007). On Multivariate analysis, treatment group, NE frequency, and age were independent predictors of CR at 2 months (P < 0.05). CONCLUSIONS Combined traditional Chinese and Western treatment in children with NE is effective and has a low relapse rate. NE frequency, treatment method, and age are important predictive factors for CR after treatment.
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Affiliation(s)
- Yanli Ma
- Department of Nephrology, Beijing Children's Hospital, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Capital Medical University, Xicheng District, Beijing, China
| | - Xiaomei Liu
- Department of Nephrology, Beijing Children's Hospital, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Capital Medical University, Xicheng District, Beijing, China
| | - Ying Shen
- Department of Nephrology, Beijing Children's Hospital, National Center for Children's Health, Beijing Key Laboratory of Chronic Kidney Disease and Blood Purification of Children, Capital Medical University, Xicheng District, Beijing, China
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