Case Report on High Dose Lithium Treatment for Post-COVID Depression, Recurrent Fevers, and Skin Lesions

This is a case of a 35-year-old woman who presented with an 18-month history of post (long)-COVID depression and exhaustion along with recurrent fevers and treatment-resistant skin boils, all of which abated with lithium treatment at a serum level of 1.14 mmol/L, and all of which worsened when the lithium serum level was lowered to 0.8. This paper illustrates Lithium's effectiveness in the treatment of post (long)-COVID syndrome, though a higher serum concentration may be required.

[Determination of trace anions in battery-grade lithium carbonate by double-inhibition on-line matrix-removal ion chromatography]

A method was developed for the determination of trace anions in battery-grade lithium carbonate. In this method, lithium carbonate was dissolved in ultrapure water with ultrasound assistance, and its matrix was removed using an on-line matrix-removal method. In the matrix-removal process, the sample was first passed through an ADRS600(4 mm) suppressor (suppressor current, 150 mA; external water flow rate, 2 mL/min). Hydrogen and lithium ions were then completely exchanged via the ion-exchange membrane in the suppressor, converting the lithium carbonate into carbonic acid. The carbonic acid entered the waste-liquid channel in the form of carbon dioxide through a CRD 200(4 mm) carbonate removal device to remove the lithium carbonate matrix. Finally, the target anions were automatically enriched on an IonPac UTAC-LP2 concentration column (35 mm×3 mm) and automatically transferred to a chromatographic system using valve-switching technology. The chromatographic system featured an IonPac AG18 column (50 mm×2 mm) as the protection column and an IonPac AS18 column (250 mm×2 mm) as the analytical column. The column temperature was 30 ℃, gradient elution was performed using KOH solution as the eluent, and the pump flow rate was 0.30 mL/min. An ADRS600(2 mm) suppressor, suppressor current of 25 mA, injection volume of 250 μL, and conductance detector were also used. The results showed good linear relationships (r≥ 0.999) for F-, Cl-, [Formula: see text] in their respective concentration ranges. The limits of detection (LODs) and quantification (LOQs) were 0.05-0.88 and 0.15-2.92 μg/L, respectively. Lithium carbonate samples were tested six consecutive times, and the relative standard deviations (RSDs) of the peak areas of each ion were less than 0.73%. The same lithium carbonate samples were injected after 0, 2, 4, 8, 12, 18, and 24 h, and the RSD of the peak areas of each ion was less than 0.96%. The average recoveries ranged from 93.3% to 99.3%, and the RSDs (n=6) of samples spiked at three levels were in the range of 0.97%-3.45%. The proposed method has a low method limit of quantification of only 0.5 mg/kg for each ion analyzed and is capable of the simultaneous analysis of multiple ions. Thus, it is suitable for the detection of trace anions in battery-grade lithium carbonate.

Hemodynamics and arrhythmia disorder caused by lithium poisoning: A case report

Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes. Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder. However, its therapeutic dosage closely approaches toxic levels. Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L, typically giving rise to gastrointestinal and central nervous system reactions. Cardiac toxicity is rare but serious in cases of lithium poisoning. The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers. This resulted in symptoms such as arrhythmia, shock, impaired consciousness, and coarse tremors. Following symptomatic supportive treatment, including blood dialysis, the patient's physical symptoms gradually improved. It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.

Rich-Carbonyl Carbon Catalysis Facilitating the Li2 CO3 Decomposition for Cathode Lithium Compensation Agent

The active lithium loss of lithium-ion batteries can be well addressed by adding a cathode lithium compensation agent. Due to the poor conductivity and electrochemical activity, lithium carbonate (Li2 CO3 ) is not considered as a candidate. Herein, an effective cathode lithium compensation agent, the recrystallized Li2 CO3 combined with large specific surface area disordered porous carbon (R-LCO@SPC) is prepared. The screened SPC makes it easier for nano-sized Li2 CO3 to adsorb and decompose on carbon substrate, meantime, exposing plenty of catalytic active sites of C═O, which can significantly improve the electrochemical activity and conductivity of Li2 CO3 , thus greatly reducing the decomposition potential of Li2 CO3 (4.0 V) and releasing high irreversible capacity (580 mAh g-1 ) compared to the unmodified Li2 CO3 (nearly no capacity above 4.6 V). Meantime, the Li2 CO3 can disappear completely without any by-product after the initial cycle accompanied by partially dissolved in electrolyte, optimizing the composition of SEI. The resultant lithium compensation agent applied to LMFP//graphite full cell exhibits a 19.1% increase in energy density, enhancing the rate and cycling performance, demonstrating great practical applications potential in high energy density lithium-ion batteries.

Chronic Lithium Intoxication: A Challenging Diagnosis

Lithium has been used in clinical practice since the 1970s. This medication is commonly used to treat and prevent bipolar disorder, but it has a narrow therapeutic index, making toxicity a frequent occurrence. Chronic lithium intoxication can arise due to progressive accumulation, particularly in contexts of dehydration. The effects of chronic lithium intoxication on the nervous, renal, and cardiac systems, as well as on the thyroid and parathyroid glands, are well documented in the literature. The authors present the case of a 66-year-old woman with schizoaffective psychosis and chronic kidney disease, admitted due to altered mental status and dysarthria. Notwithstanding an earlier clinical recommendation to cease lithium administration more than a year ago, the patient continued its usage, culminating in neurological, cardiac, renal, and endocrine manifestations. Although the diagnosis was delayed, her clinical progression was favorable, obviating the need for renal replacement therapy. This case highlights the importance of a detailed medical history and the diagnostic challenges in clinical practice. The use of this drug without proper monitoring can lead to multisystem dysfunction.

Amorphization of Inorganic Solid Electrolyte Interphase Components and Its Impact on Enhancing Their Transport and Mechanical Properties

The safety and cycle life of lithium-ion batteries (LIBs) are largely determined by the solid electrolyte interphase (SEI) formed on the surface of the anode. However, there is still a lack of understanding regarding the structure and properties of the individual SEI components. Among others, lithium oxide (Li2O), lithium carbonate (Li2CO3), and lithium fluoride (LiF) are known to be the main components of the inorganic SEI layer in conventional LIBs, but their intrinsic protective roles remain controversial. Herein, we present the transformational effects of their amorphous phase on the mechanical and transport characteristics, based on first-principles calculations. Our studies clearly demonstrate that their amorphous phases exhibit significantly improved Li-ion conductivity when compared to the crystalline structures. Additionally, among them, amorphous LiF emerges as a frontrunner for fast Li+ ion transportation, reversing the conventionally understood hierarchy. Under ambient conditions, the amorphous phases of LiF, Li2O, and Li2CO3 are thermodynamically unstable and tend to undergo recrystallization. However, this work highlights that exceptionally ductile and resilient amorphous phases can form if SEI formation and growth would involve some admixing of lithiophilic impurities like nitrogen (N) within the host matrices.

Study on Early Hydration Mechanism of Double-Liquid Grouting Material Modified by Composite Early Strength Agent

To achieve an adjustable setting time and significantly improved early strength of a new type of sulphoaluminate cement-based double-liquid grouting material (SACDL), the effects of calcium formate, sodium sulfate, lithium carbonate, and a composite early strength agent on the setting hardening and early hydration behavior of SACDL paste were studied by means of setting time, fluidity, compressive strength, and viscosity tests. The results showed that the adsorption and osmosis of calcium formate, the complex decomposition of sodium sulfate, the precipitation polarization of lithium carbonate and the synergistic action of the composite early strength agent could accelerate the early hydration rate of SACDL, shorten the coagulation time, and improve the early strength of SACDL. The composite effect of 0.8% calcium formate and 0.5% sodium sulfate is the most significant in promoting coagulation and early strength; the initial setting time and final setting time of the slurry were shortened to 5 min and 10 min, respectively; and the 3 h compressive strength was capable of reaching 16.7 MPa, 31% higher than that of the blank group. In addition, X-ray diffraction and SEM morphology observation were used to study the composition of the hydration products and the evolution of the microstructure, which revealed the early hydration mechanism of SACDL under the synergistic effect of the composite early strength agent: (1) The solubility of tricalcium aluminate (C3A) and dihydrate gypsum (CaSO4·2H2O) increased under the low content composite early strength agent condition, which increased the ettringite (AFt) formation rate. HCOO- was able to penetrate the hydration layers of tricalcium silicate (C3S) and dicalcium silicate (C2S), accelerating the dissolution of C3S and C2S and promoting the early hydration of SACDL. (2) Under the condition of a high dosage of the composite early strength agent, the further increase in Ca2+ concentration promoted the crystallization nodules and precipitation of CH and accelerated the formation of calcium silicate hydrate (C-S-H) gel. C-S-H was filled between a large number of rod-like AFt crystals, thus making the structure more dense.

Multi-trial, aggregated, individual participant data mega-analysis of short-term antidepressant versus mood stabilizer monotherapy of bipolar type II major depressive episode

BACKGROUND

Few studies have systematically examined the safety and effectiveness of antidepressant versus mood stabilizer monotherapy of bipolar II depression. To date, there are no aggregated or mega-analyses of prospective trials of individual participant-level data (IPD) to inform future treatment guidelines on the relative safety and effectiveness of antidepressant or lithium monotherapy.

METHODS

Data from a series of four independent, similarly designed trials of antidepressant or lithium monotherapy (where longitudinal IPD were available) (n = 393) were aggregated into an IPD dataset (i.e., mega-analysis). Hierarchical log-linear growth models were used to analyze primary outcome of change over time in Hamilton Rating Scale for Depression (HRSD) scores; while secondary outcomes examined Clinical Global Impressions severity (CGI/S) and change (CGI/C) scores, and change over time in Young Mania Rating (YMR) scores.

RESULTS

Relative to lithium monotherapy, antidepressant monotherapy demonstrated significantly greater symptom reduction on HRSD scores across time (b = -2.33, t = -6.68, p < 0.0001), significantly greater symptom reduction on the CGI/S across time (b = -0.414, t = -6.32, p < 0.001), and a significant improvement in CGI/C across time (b = -0.47, t = -7.43, p < 0.0001). No differences were observed in change over time for YMR scores between antidepressant and lithium monotherapy (b = 0.06, t = 0.49, p = 0.62).

CONCLUSION

Findings from this IPD mega-analysis of bipolar II depression trials suggest a divergence from current evidence-based guidelines recommending combined mood stabilizer plus antidepressant therapy. The current mega-analysis suggests that antidepressant monotherapy may provide superior short-term effectiveness without clinically meaningful increase in treatment-emergent hypomanic symptoms compared to lithium monotherapy.

Electrolyte-Impregnated Mesoporous Hollow Microreactor to Supplement an Inner Reaction Pathway for Boosting the Cyclability of Li-CO2 Batteries

Li-CO2 batteries that integrate energy storage with greenhouse gas fixation have received a great deal of attention in the pursuit of carbon neutrality. However, cyclic accumulation of the insulative and insoluble Li2CO3 on the cathode surface severely restrains the battery cyclability, especially under a high depth of discharge/charge. Herein, we design and fabricate a microreactor-type catalyst by embedding Ru nanoparticles into the shells of mesoporous hollow carbon spheres. We show that both the hollow cavity and mesoporous shell are indispensable for concertedly furnishing a high activity to catalyze reversible Li2CO3 formation/decomposition. This unique structure ensures that the Ru sites masked by exterior Li2CO3 deposits during charging can resume the redox process of discharge by working with the prestored electrolyte to establish an inner reaction path. The thus fabricated Li-CO2 batteries demonstrate remarkable cyclability of 1085 cycles under 0.5 Ah g-1 and 326 cycles under 2 Ah g-1 at 1 A g-1, outshining most of the literature reports. This study highlights a smart catalyst design to boost the reversibility and cyclability of Li-CO2 batteries through an "in & out" strategy.

"Addressing the core trait of bipolar disorder": A concept analysis of mood-stabilizing drugs

OBJECTIVE

The term "mood stabilizer" is controversial in the literature and criticized for being imprecise and overly inclusive, having its retirement suggested to avoid misuse. Nevertheless, it continues to be employed as it may still carry important meaning.

METHODS

We employed document analysis for reviewing relevant definitions of mood stabilizer employed in the literature. Then, we clarify the meanings associated with the term by employing evolutionary concept analysis. Based on its results, we present a theoretical model for a mood stabilizer and further match it with evidence gathered from published meta-analyses and other sources for drugs used in the treatment of bipolar disorder.

RESULTS

Concept analysis unearthed four attributes of a mood stabilizer that were nested into the following ascending hierarchy: "not worsening," "acute effects," "prophylactic effects," and "advanced effects." "Prophylactic effects" were often considered the core aspect of a legitimate mood stabilizer.

CONCLUSION

The proposed model uses a hierarchy of attributes that take into account the complexity of the term and help to determine whether a drug is a mood stabilizer. Prophylaxis is pivotal to the concept, whose utility lies in implying a drug able to truly treat bipolar disorder, as opposed to merely targeting symptoms. Consistent use of the term could encourage investigation of drugs that modify long-term outcomes and illness trajectory, instead of simply approaching symptom clusters.

Study of Lithium Biodistribution and Nephrotoxicity in Skin Melanoma Mice Model: The First Step towards Implementing Lithium Neutron Capture Therapy

Boron neutron capture therapy (BNCT) is one of the promising treatment methods for malignant melanoma. The main issue of this technology is the insufficient selectivity of ¹⁰B accumulation in tumor cells. As a result of the neutron absorption by boron, an 84% energy release occurred within the cell by the nuclear reaction ¹⁰B (n, α)⁷Li, which lead to tumor cell death. The use of lithium instead of boron brings a new unique opportunity-local 100% energy release-since all products of the ⁶Li (n, α)³H reaction have high linear energy transfer characteristics. The aim of this study was to determine the concentrations of Li in the tumor, skin, blood, brain and kidney in experimental animals with B16 melanoma and to analyze the potential Li toxicity after lithium carbonate administration at single doses of 300 and 400 mg/kg. Lithium carbonate was chosen since there is a long-term experience of its use in clinical practice for the treatment of psychiatric disorders. The inductively coupled plasma atomic emission spectrometry was used to evaluate Li concentrations in tissue samples. The accumulation efficiency of Li in the tumor was the highest at a time point of 30 min (22.4 µg/g; at a dose of 400 mg/kg). Despite the high lithium accumulation in the kidneys, the pathological changes in kidney tissues were not found. Thus, lithium may actually be used for the Li-NCT development and future studies can be conducted using ⁶Li and following irradiation of tumor cells using the schemes of lithium administration tested in this work.

Central Diabetes Insipidus in the Background of Lithium Use: Consider Central Causes Despite Nephrogenic as the Most Common

BACKGROUND Nephrogenic diabetes insipidus is a well-known adverse effect of lithium use. Albeit rare, there have also been documented cases of central diabetes insipidus (CDI) associated with lithium use. CASE REPORT A 31-year-old woman with a past medical history of bipolar disorder, managed with lithium 300 mg by mouth every day for 3 years, was assessed for a 1-year history of polyuria with accompanying polydipsia. During her initial hospital stay, her estimated urine output was more than 4 L per day. Initial labs showed elevated serum sodium (149 mmol/L; reference range 135-145), elevated serum osmolality (304 mOsm/kg; reference range 275-295), urine osmolality of 99 mOsm/kg (reference range 50-1200), and urine specific gravity (1.005; reference range 1.005-1.030). Lithium was at a subtherapeutic level of 0.05 mEq/L (reference range 0.6-1.2). Magnetic resonance imaging of the brain revealed no abnormalities of the pituitary gland. Two different occasions of desmopressin administration resulted in >50% increase in urine osmolality, confirming the diagnosis of CDI. Common causes of CDI, including trauma, tumors, and familial CDI, were ruled out and chronic lithium use was determined as the most probable cause for the patient's CDI. CONCLUSIONS CDI in the background of chronic lithium use is rarely reported. We present this case to consider CDI as a differential diagnosis when evaluating polyuria and hypernatremia in patients with long-term lithium use. These presentations warrant the consideration of both types of diabetes insipidus in the differential diagnoses.

Titration Mass Spectroscopy (TMS): A Quantitative Analytical Technology for Rechargeable Batteries

Development of high-energy-density rechargeable battery systems not only needs advanced qualitative characterizations for mechanism exploration but also requires accurate quantification technology to quantitatively elucidate products and fairly assess numerous modification strategies. Herein, as a reliable quantification technology, titration mass spectroscopy (TMS) is developed to accurately quantify O-related anionic redox reactions (Li-O₂ battery and nickel-cobalt-manganese (NCM)/Li-rich cathodes), parasitic carbonate deposition and decomposition (derived from air-exposure degradation and electrolyte oxidation), and dead Li⁰ formation (Li-metal battery and over-discharged graphite anode). TMS technology can harvest key information on products (e.g., quantification of oxidized lattice oxygen and solid electrolyte interphase (SEI)/cathode electrolyte interphase (CEI) components) and guide corresponding design strategy by enhancing understanding of the mechanism (e.g., clearly distinguish the catalytic target of highly oxidative Ni⁴⁺ on the NCM cathode). Not limited as a rigid quantification tool for widely known products/mechanisms, TMS technology has been demonstrated as a powerful and versatile tool for the investigations of advanced batteries.

The development and validation of a prediction model of lithium carbonate blood concentration by artificial neural network: a retrospective study

BACKGROUND

Bipolar disorder (BD) is common in clinical practice. Lithium (Li) carbonate is often used in the treatment of BD. However, the therapeutic dose of Li carbonate is close to the toxic dose, and Li poisoning is prone to occur. Precise prediction of Li concentration will help clinician to identify patients at high risk of toxic dose of Li carbonate. The purpose of this study was to establish a model for predicting the blood concentration of Li carbonate through an artificial neural network (ANN), and to provide a basis for the clinical rapid and effective formulation of individualized dosing regimens.

METHODS

Patients with BD who were diagnosed and treated in our hospital from October 2016 to April 2021 were enrolled as the research participants. We collected patient demographic data, including age and gender; physical examination information, including height and weight; laboratory test results, including liver and renal function, and Li concentrations; medication information, including Li carbonate usage, concomitant medications, and dose; and information on comorbidities and adverse reactions. The Li concentration data of 236 patients were randomly divided into 2 groups: 195 cases in the training group and 41 cases in the test group. The ANN fitting module of SPSS 26.0 was used for modeling and prediction.

RESULTS

A total of 236 patients with BD were included in this study. Daily dose (before testing Li concentration), age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TBIL), and creatinine (Cr), and co-administered zopiclone, quinine, tipine, lorazepam, olanzapine, valproate, metoprolol, and statins were used as model input variables for training. The test results of the model in the testing group showed that the correlation coefficient between the predicted value of Li concentration and the actual value was r=0.9883, r2=0.9767, P<0.001, the prediction error range was -0.05 to 0.07 mmol/L, and the deviation range was -18.52 to 13.04%; the mean absolute error was 0.03, and the mean prediction error deviation was between -10% and 10% in 33 cases (80.5%).

CONCLUSIONS

The correlation, accuracy, and precision of ANN prediction are worthy to be further investigated to predict the blood concentration of Li carbonate.

Carbonate-superstructured solid fuel cells with hydrocarbon fuels

A basic requirement for solid oxide fuel cells (SOFCs) is the sintering of electrolyte into a dense impermeable membrane to prevent the mixing of fuel and oxygen for a sufficiently high open-circuit voltage (OCV). However, herein, we demonstrate a different type of fuel cell, a carbonate-superstructured solid fuel cell (CSSFC), in which in situ generation of superstructured carbonate in the porous samarium-doped ceria layer creates a unique electrolyte with ultrahigh ionic conductivity of 0.17 S⋅cm^-1 at 550 °C. The CSSFC achieves unprecedented high OCVs (1.051 V at 500 °C and 1.041 V at 550 °C) with methane fuel. Furthermore, the CSSFC exhibits a high peak power density of 215 mW⋅cm^-2 with dry methane fuel at 550 °C, which is higher than all reported values of electrolyte-supported SOFCs. This provides a different approach for the development of efficient solid fuel cells.

Pristine Surface of Ni-Rich Layered Transition Metal Oxides as a Premise of Surface Reactivity

The surface reactivity of Ni-rich layered transition metal oxides is instrumental to the performance of batteries based on these positive electrode materials. Most often, strong surface modifications are detailed with respect to a supposed ideal initial state. Here, we study the LiNi_0.8Mn_0.1Co_0.1O₂ (NMC811) cathode material in its pristine state, hence before any contact with electrolyte or cycling, thanks to advanced microscopy and spectroscopy techniques to fully characterize its surface down to the nanometer scale. Scanning transmission electron microscopy-electron energy loss spectroscopy (STEM-EELS), solid-state nuclear magnetic resonance (SS-NMR), and X-ray photoelectron spectroscopy (XPS) are combined and correlated in an innovative manner. The results demonstrate that in usual storage conditions after synthesis, the extreme surface is already chemically different from the nominal values. In particular, nickel is found in a reduced state compared to the bulk value, and a Mn enrichment is determined in the first few nanometers of primary particles. Further exposition to humid air allows for quantifying the formed lithiated species per gram of active material, identifying their repartition and proposing a reaction path in relation with the instability of the surface.

Later onset of Childhood Disintegrative Disorder (CDD): a case report

Childhood Disintegrative Disorder (CDD) is a rare condition characterized by regression of developmental and behavioral functioning after a period of apparently normal development, with an age of onset around 4 years. CDD is not included within the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. We present a case report of an 11-year-old male who achieved normal development for up to 7 years followed by a deterioration of previously acquired linguistic, intellectual, and social skills. Following treatment with lithium carbonate combined with risperidone, the patient experienced a reduction in irritability and aggression. CDD is a rare condition; therefore, the data presented may be useful to investigate its characteristics of the onset, to improve the understanding of the aspects of differentiation from the Autism Spectrum Disorder and finally to propose the possibility of treatment.

Under lithium carbonate administration, nicotine triggers cell dysfunction in human glioblastoma U-251MG cells, which is distinct from cotinine

Nicotine is an alkaloid found in tobacco leaves. Smoking prevention has been a neglected issue in psychiatry; nicotine intake in conjunction with the administration of the mood stabilizer, lithium carbonate (Li₂CO₃), may negatively affect brain cells. The present study investigated the combined effects of nicotine and its metabolite, cotinine, and Li₂CO₃ compared to acetylcholine and dopamine in U-251MG human glioblastoma cells. Cell proliferation was found to be decreased by nicotine and to be further suppressed following treatment with Li₂CO₃, accompanied by mitotic catastrophe and increased levels of superoxide anion radicals. By contrast, cotinine did not exert such detrimental effects. It was also found that acetylcholine did not suppress cell proliferation, whereas dopamine in conjunction with Li₂CO₃ decreased cell proliferation in a concentration-dependent manner. The nicotine-induced cell growth inhibition was restored by mecamylamine, a non-competitive antagonist of nicotinic acetylcholine receptors. On the whole, the findings of the present study suggest that nicotine combined with Li₂CO₃ leads to the suppression of the proliferation of human glioblastoma cells accompanied by mitotic catastrophe and superoxide anion radical generation. These findings may provide further cellular biological insight into the risks associated with smoking under Li₂CO₃ administration.

Homogenizing Li2CO3 Nucleation and Growth through High-Density Single-Atomic Ru Loading toward Reversible Li-CO2 Reaction

The high activation barrier and sluggish kinetics of Li₂CO₃ decomposition impose a severe challenge on the development of a Li-CO₂ battery with high Coulombic efficiency. To tackle this issue, herein we devise a novel synthetic tactic by combining electrostatic assembly with in situ polycondensation to obtain a single-atomic Ru catalyst of high density up to ∼5 wt %. When deployed to the CO₂ cathode, the catalyst delivered an extraordinary capacity of 44.7 Ah g^-1, an ultralow charge/discharge polarization of 0.97 V at 0.1 A g^-1 (1.90 V at 2 A g^-1), and a long-term cycling stability up to 367 cycles at 1 Ah g^-1 (196 cycles at 2 Ah g^-1), outshining most of the state-of-the-art CO₂ cathode catalysts reported today. Further through extensive in situ and ex situ electroanalytical, spectroscopic, and microscopic characterizations, we attribute the superb battery performance mainly to the highly reversible Li₂CO₃ formation/decomposition, facilitated by the homogenized and downsized Li₂CO₃ nucleation and growth on account of the high density single-atomic Ru loading. This work not only offers a facile method to fabricate single-atom catalysts with high mass loading but also sheds light on promoting the reversible Li-CO₂ reaction by mediating product morphology.

Insights into Chronic Lithium Toxicity - A Case Report

BACKGROUND

Bipolar disorder is a chronic psychological disorder, and lithium remains the mainstay of therapy. Lithium toxicity can be acute or chronic and the effects may be disabling or life-threatening. The presence of risk factors can increase the chances of lithium toxicity in a patient on long-term lithium therapy. We hereby report a case of chronic lithium toxicity in a patient with a known case of bipolar disorder.

CASE PRESENTATION

A 44-year-old female patient with a known case of bipolar disorder presented with altered sensorium, seizures, and renal insufficiency. On admission, the patient was severely dehydrated and the serum lithium level was 3.43 mEq/L. Hemodialysis was performed and she improved gradually.

CONCLUSION

Lithium has constantly proven to be beneficial in lowering suicide rates in bipolar disorder patients over the years since its approval. However, its use is limited due to the risk of toxicity. The chances of developing toxicity are higher in patients on long-term lithium therapy. Patients with high risk factors for toxicity should be monitored frequently as the effects of lithium toxicity can be fatal.

Effect of antipsychotics on serum lithium levels and white blood cell counts

Lithium carbonate is used to increase white blood cell counts as a means of counteracting leukopenia caused by the administration of antipsychotic drugs. To evaluate the effect of antipsychotics on the leukocyte-enhancing effect of lithium, we compared white blood cell counts, serum lithium levels, and lithium dosage in patients receiving antipsychotics and lithium in combination and patients receiving lithium alone. Chlorpromazine equivalent values were used as an indicator of the antipsychotic dose. Lithium serum levels were measured in 41 hospitalized patients. The lithium dose in the combination group (median, 800 mg) was significantly higher than that in group receiving only lithium (median, 400 mg) (P = 0.03). The lithium doses in the combination group receiving ≥1000 mg chlorpromazine equivalents (overdosing; median lithium dose 800 mg) and the combination group treated with 600-999 mg chlorpromazine equivalents (high dosing; median lithium dose 800 mg) were significantly higher than the group that was not treated with antipsychotic medication, with median lithium dose 400 mg (P < 0.05).There were no significant differences in the white blood cell counts and serum lithium levels. Because of the large variety of antipsychotic drugs used in combination with lithium and the various doses used, it was difficult to evaluate the effects of lithium, with or without antipsychotic administration, on leukocyte count enhancement. We are planning to study a larger number of patients and, since renal function could not be assessed in this study, we will also focus on renal function, including urine output.

Combined Neuroprotective Strategies Blocked Neurodegeneration and Improved Brain Function in Senescence-Accelerated Mice

Increase in the quality of life, combined with drug strategies, has been studied as possibilities for improving memory and delaying the onset of neurodegenerative diseases. A previous study published by the group of the authors has shown that microdose lithium and enriched environment can improve memory in both mice and humans. To elucidate this relationship better, this study aimed to evaluate whether the chronic combination of these two strategies could increase healthy aging in Senescence Accelerated Mouse-Prone 8 (SAMP8). Animals were submitted to either one or both of these strategies until the age of 10 months when they were anesthetized and killed and their hippocampus was extracted. The untreated SAMP-8 group exhibited worse memory and reduced neuronal density with greater neurodegeneration and increased amyloid-β plaque density compared with the control group. Moreover, significant alterations in proteins related to long-term potentiation, such as, synaptophysin and brain-derived neurotrophic factor (BDNF), were observed in this group. The strategies used in the study maintained long-term memory, reduced anxiety, and increased neuroprotection. Both strategies were efficient in reducing neurodegeneration and increasing parameters related to memory maintenance. In many experiments, the combination of the two strategies was more effective in improving healthy aging. This study sheds light on the combination of strategies that choose to improve the quality of life and drugs with low side effects. Moreover, it opens perspectives for a new field of study for healthy aging.

Green tea extract modulates lithium-induced thyroid follicular cell damage in rats

BACKGROUND

The aim of the current work was to clarify the modulation role of green tea extract (GTE) over structural and functional affection of the thyroid gland after long term use of lithium carbonate (LC). The suggested underlying mechanisms participating in thyroid affection were researched.

MATERIALS AND METHODS

Twenty-four Sprague-Dawley adult albino rats were included in the work. They are divided into three groups (control, LC, and concomitant LC + GTE). The work was sustained for 8 weeks. Biochemical assays were achieved (thyroid hormone profile, IL-6). Histological, histochemical (PAS) and immunohistochemical (caspase-3, TNF-α, PCNA) evaluations were done. Oxidative/antioxidative markers (MDA / GSH, SOD) and western blot evaluation of the Bcl2 family were done.

RESULTS

LC induced hypothyroidism (decrease T3, T4/increase TSH). The follicles were distended, others were involuted. Some follicles were disorganized, others showed detached follicular cells. Apoptotic follicular cells were proved (Bax and caspase-3 increased, Bcl2 decreased, Bax/Bcl2 ratio increased). The collagen fibers' content and proinflammatory markers (TNF-α and IL-6) increased. The proliferative nuclear activity was supported by increase expression of PCNA. Oxidative stress was established (increase MDA/decrease GSH, SOD). With the use of GTE, the thyroid hormone levels increased, while the TSH level decreased. Apoptosis is improved as Bax decreased, Bcl2 increased, and Bax/Bcl2 ratio was normal. The collagen fibers' content and proinflammatory markers (TNF-α and IL-6) decreased. The expression of PCNA and caspase-3 were comparable to the control group. The oxidative markers were improved (decrease MDA/increase GSH, SOD).

CONCLUSIONS

In conclusion, prolonged use of LC results in hypothyroidism, which is accompanied by structural thyroid damage. LC induced thyroid damage through oxidative stress that prompted sterile inflammation and apoptosis. With the use of GTE, the thyroid gland achieved its structure and function. The protecting role of GTE is through antioxidant, antifibrotic, anti-inflammatory, and antiproliferative effects.

Deciphering the Enigma of Li2CO3 Oxidation Using a Solid-State Li-Air Battery Configuration

Li₂CO₃ is a ubiquitous byproduct in Li-air (O₂) batteries, and its accumulation on the cathode could be detrimental to the devices. As a result, much efforts have been devoted to investigating its formation and decomposition, in particular, upon cycling of Li-O₂ batteries. At high voltages, Li₂CO₃ is expected to decompose into CO₂ and O₂. However, as recognized from the work of many authors, only CO₂, and no O₂, has been identified, and the underlying mechanism remains uncertain so far. Herein, a solid-state Li-O₂ battery (Li|Li_6.4La₃Zr_1.4Ta_0.6O₁₂|Au) has been designed to interrogate the Li₂CO₃ oxidation without interferences from the decomposition of other battery components (organic electrolyte, binder, and carbon cathode) widely applied in conventional Li-O₂ batteries. It is revealed that Li₂CO₃ can indeed be oxidized to CO₂ and O₂ in a more stable solid-state Li-O₂ battery configuration, highlighting the feasibility of reversible operation of Li-O₂ batteries with ambient air as the feeding gas.

Very rare case of Graves' disease with resistance to methimazole: a case report and literature review

Background

Methimazole (MMI) is used to treat hyperthyroidism in Graves’ disease. It is rare to encounter patients in whom hyperthyroidism cannot be controlled using high doses of MMI.

Case presentation: A 21-year-old woman was referred to our hospital because of MMI-resistant Graves’ disease. Although her MMI dose had been increased to 120 mg/day, her serum thyroid hormone concentration was too high to be measured. Additional therapy with lithium carbonate, and then with dexamethasone and inorganic iodine, was initiated. After 14 days, the patient’s serum thyroid hormone concentration normalized, while she was taking 150 mg/day MMI, 800 mg/day lithium carbonate, 6 mg/day dexamethasone and 306 mg/day inorganic iodine, and total thyroidectomy was then performed. The patient was discharged 8 days after the thyroidectomy and experienced no major complications.

Conclusions

We have presented a rare case of Graves’ disease that was resistant to high-dose MMI. Combination therapy of MMI with lithium carbonate, dexamethasone and inorganic iodine may represent a therapeutic option for the preoperative preparation of patients with MMI-resistant Graves’ disease.

Recovery of Acid and Base from Sodium Sulfate Containing Lithium Carbonate Using Bipolar Membrane Electrodialysis

Lithium carbonate is an important chemical raw material that is widely used in many contexts. The preparation of lithium carbonate by acid roasting is limited due to the large amounts of low-value sodium sulfate waste salts that result. In this research, bipolar membrane electrodialysis (BMED) technology was developed to treat waste sodium sulfate containing lithium carbonate for conversion of low-value sodium sulfate into high-value sulfuric acid and sodium hydroxide. Both can be used as raw materials in upstream processes. In order to verify the feasibility of the method, the effects of the feed salt concentration, current density, flow rate, and volume ratio on the desalination performance were determined. The conversion rate of sodium sulfate was close to 100%. The energy consumption obtained under the best experimental conditions was 1.4 kWh·kg^-1. The purity of the obtained sulfuric acid and sodium hydroxide products reached 98.32% and 98.23%, respectively. Calculated under the best process conditions, the total process cost of BMED was estimated to be USD 0.705 kg^-1 Na₂SO₄, which is considered low and provides an indication of the potential economic and environmental benefits of using applying this technology.

Ring-Shaped Baffle Effect on Separation Performance of Lithium Carbonate Micro Particles in a Centrifugal Classifier

In this work, a centrifugal classifier for separating lithium carbonate particles, used as a cathode material for lithium-ion batteries, was investigated. This work numerically evaluates the internal flow and particle separation performance of the centrifugal classifier. The complex turbulent flow field in the classifier is key to understanding particle motion. A Reynolds stress model, to describe air flow field, and a discrete phase model, to track particle motion, were applied to a numerical simulation. Design parameters such as mass flow rate and rotor speed were investigated, and a ring-shaped baffle, in particular, was designed to investigate the effects of flow and particle separation in the centrifugal classifier. The simple geometry of the baffle changes the movement direction of unseparated particles to the rotor cage region, and increases the local air velocity in the separation zone. The numerical analysis results were verified through a baffle experiment.

Does Lithium Deserve a Place in the Treatment Against COVID-19? A Preliminary Observational Study in Six Patients, Case Report

Lithium has shown the capacity to: a) inhibit the replication of several types of viruses, some of which are similar to the SARS-CoV-2 virus, b) increase the immune response by reducing lymphopenia, and c) reduce inflammation by preventing or reducing the cytokine storm. In the present study, we have treated six patients with severe COVID-19 infection with lithium carbonate. We found that lithium carbonate significantly reduced plasma reactive C-Protein levels, increased lymphocyte numbers and decreased the neutrophil-lymphocyte ratio, improving both inflammatory activity and the immune response in these patients. We propose that lithium carbonate may deserve a place in the treatment against COVID-19.

Dissecting the Epigenetic Changes Induced by Non-Antipsychotic Mood Stabilizers on Schizophrenia and Affective Disorders: A Systematic Review

BACKGROUND

Epimutations secondary to gene-environment interactions have a key role in the pathophysiology of major psychiatric disorders. In vivo and in vitro evidence suggest that mood stabilizers can potentially reverse epigenetic deregulations found in patients with schizophrenia or mood disorders through mechanisms that are not yet fully understood. However, their activity on epigenetic processes has made them a research target for therapeutic approaches.

METHODS

We conducted a comprehensive literature search of PubMed and EMBASE for studies investigating the specific epigenetic changes induced by non-antipsychotic mood stabilizers (valproate, lithium, lamotrigine, and carbamazepine) in animal models, human cell lines, or patients with schizophrenia, bipolar disorder, or major depressive disorder. Each paper was reviewed for the nature of research, the species and tissue examined, sample size, mood stabilizer, targeted gene, epigenetic changes found, and associated psychiatric disorder. Every article was appraised for quality using a modified published process and those who met a quality score of moderate or high were included.

RESULTS

A total of 2,429 records were identified; 1,956 records remained after duplicates were removed and were screened via title, abstract and keywords; 129 records were selected for full-text screening and a remaining of 38 articles were included in the qualitative synthesis. Valproate and lithium were found to induce broader epigenetic changes through different mechanisms, mainly DNA demethylation and histones acetylation. There was less literature and hence smaller effects attributable to lamotrigine and carbamazepine could be associated overall with the small number of studies on these agents. Findings were congruent across sample types.

CONCLUSIONS

An advanced understanding of the specific epigenetic changes induced by classic mood stabilizers in patients with major psychiatric disorders will facilitate personalized interventions. Further related drug discovery should target the induction of selective chromatin remodeling and gene-specific expression effects.

Lithium and coronaviral infections. A scoping review

The current rapid spread of the novel coronavirus (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) calls for a rapid response from the research community. Lithium is widely used to treat bipolar disorder, but has been shown to exhibit antiviral activity. This brief review took a systematic approach to identify six in vitro studies reporting on the influence of lithium on coronaviral infections. We propose mechanistic investigation of the influence of lithium - alone and with chloroquine - on the SARS-CoV-2 infection.

Lithium and coronaviral infections. A scoping review

The current rapid spread of the novel coronavirus (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) calls for a rapid response from the research community. Lithium is widely used to treat bipolar disorder, but has been shown to exhibit antiviral activity. This brief review took a systematic approach to identify six in vitro studies reporting on the influence of lithium on coronaviral infections. We propose mechanistic investigation of the influence of lithium – alone and with chloroquine – on the SARS-CoV-2 infection.

Dual Role of Lithium on the Structure and Self-Healing Ability of PMMA-Silica Coatings on AA7075 Alloy

In this work, structural and active corrosion inhibition effects induced by lithium ion addition in organic-inorganic coatings based on poly(methyl methacrylate) (PMMA)-silica sol-gel coatings have been investigated. The addition of increasing amounts of lithium carbonate (0, 500, 1000, and 2000 ppm), yielded homogeneous hybrid coatings with increased connectivity of nanometric silica cross-link nodes, covalently linked to the PMMA matrix, and improved adhesion to the aluminum substrate (AA7075). Electrochemical impedance spectroscopy (EIS), performed in 3.5% NaCl aqueous solution, showed that the improved structural properties of coatings with higher lithium loadings result in an increased corrosion resistance, with an impedance modulus up to 50 GΩ cm², and revealed that the lithium induced self-healing ability significantly improves their durability. Time-of-flight secondary ion mass spectrometry (ToF-SIMS) and X-ray photoelectron spectroscopy (XPS) suggest that the regeneration process occurs by means of lithium ions leaching from the adjacent coating toward the corrosion spot, which is restored by a protective layer of precipitated Li rich aluminum hydroxide species. An analogue mechanism has been proposed for artificially scratched coatings presenting an increase of the impedance modulus after salt spray test compared to the lithium free coating. These results evidence the active role of lithium ions in improving the passive barrier of the PMMA-silica coating and in providing through the self-restoring ability a significantly extended service life of AA7075 alloy exposed to saline environment.

Dual Role of Lithium on the Structure and Self-Healing Ability of PMMA-Silica Coatings on AA7075 Alloy

In this work, structural and active corrosion inhibition effects induced by lithium ion addition in organic-inorganic coatings based on poly(methyl methacrylate) (PMMA)-silica sol-gel coatings have been investigated. The addition of increasing amounts of lithium carbonate (0, 500, 1000, and 2000 ppm), yielded homogeneous hybrid coatings with increased connectivity of nanometric silica cross-link nodes, covalently linked to the PMMA matrix, and improved adhesion to the aluminum substrate (AA7075). Electrochemical impedance spectroscopy (EIS), performed in 3.5% NaCl aqueous solution, showed that the improved structural properties of coatings with higher lithium loadings result in an increased corrosion resistance, with an impedance modulus up to 50 GΩ cm², and revealed that the lithium induced self-healing ability significantly improves their durability. Time-of-flight secondary ion mass spectrometry (ToF-SIMS) and X-ray photoelectron spectroscopy (XPS) suggest that the regeneration process occurs by means of lithium ions leaching from the adjacent coating toward the corrosion spot, which is restored by a protective layer of precipitated Li rich aluminum hydroxide species. An analogue mechanism has been proposed for artificially scratched coatings presenting an increase of the impedance modulus after salt spray test compared to the lithium free coating. These results evidence the active role of lithium ions in improving the passive barrier of the PMMA-silica coating and in providing through the self-restoring ability a significantly extended service life of AA7075 alloy exposed to saline environment.

Cytological Characteristics of a Heterogeneous Population of Hepatocellular Carcinoma-29 Cells after Injection of Lithium Carbonate in the Experiment

Five cytological types of hepatocellular carcinoma-29 (G-29) grown in the muscle tissue of the thigh of experimental animals were identified by transmission electron microscopy; 89% of these were poorly differentiated type I-III cells. Lithium in a concentration of 20 mM produced a damaging effect on poorly differentiated G-29 cells: the number of cells with zones of intracellular component destruction and volume density of these zones increased, while volume density of cisterns of endoplasmic reticulum decreased. These results suggest that lithium carbonate can cause destructive changes in the heterogeneous population of G-29 cells during in vivo tumor development.

Altering Surface Contaminants and Defects Influences the First-Cycle Outgassing and Irreversible Transformations of LiNi0.6Mn0.2Co0.2O2

By altering the surface of LiNi_0.6Mn_0.2Co_0.2O₂ (NMC622) we show that surface defects and contaminants dominate the outgassing and irreversible surface transformations during the first electrochemical cycle. To alter the surface defects and contaminants without changing the bulk structure of the NMC622, we perform mild methanol and water rinses, a water soak, a water rinse and subsequent heat treatment, as well as purposeful increase of the surface Li₂CO₃. By combining isotopic labeling; gas analysis; and peroxide, hydroxide, and carbonate titrations we observe that these alterations change the surface Li₂CO₃, surface hydroxides, and the local defects, which in turn alter the nature and extent of the outgassing to O₂ and CO₂. Our results highlight that outgassing of Li-ion cathode materials is highly dependent on the synthesis and storage routes and comparison of varying compositions must take into account these differences to make any meaningful conclusions. We also show that simple rinsing procedures may be an effective route to controlling interfacial reactivity of Li-ion active materials.

Ultrastructural Changes in Hepatocellular Carcinoma-29 Cells after Treatment with Lithium Carbonate

We studied the effect of lithium carbonate on hepatocellular carcinoma-29 cells in CBA male mice after injection in a dose of 20 mM along the tumor periphery. Transmission electron microscopy revealed a decrease in the volume density of the granular endoplasmic reticulum in the cell cytoplasm and an increase in the total numerical and volume density of autophagosomes and autolysosomes and zones of destruction of intracellular organelles. The ability of lithium carbonate to activate intracellular degradation processes in tumor cells and to stimulate cell death can be used to develop new combined strategies in the chemotherapy for hepatocellular carcinoma.

Finding the best effective way of treatment for rapid I-131 turnover Graves' disease patients: A randomized clinical trial

BACKGROUND

Rapid I-131 turnover Graves' disease patients have low cure rate. We aimed to compare cure percentage at 12 months among 3 treatment doses of I-131 with or without lithium carbonate (LiCO3) in rapid turnover Graves' disease patients.

METHODS

Sixty Graves' disease patients referred for radioactive iodine treatment were randomised into three arms of treatment: Group A, 3.7 MBq I-131/g thyroid plus 600 mg/day LiCO3, Group B, 5.55 MBq I-131/g plus 600 mg/day LiCO3, and Group C, 7.4 MBq I-131/g without LiCO3. Data were collected at baseline, 3, 6, 9, and 12 months. The primary endpoint were cure rates (percentage of euthyroid or hypothyroid) at 12 months. Pairwise comparisons were made across 3 groups using an equality of proportions test. The secondary endpoint, the odds of cure over the total follow-up for group B and C versus group A, was analyzed using generalized estimating equation (GEE). Side effects of I-131 and LiCO3 treatment were evaluated at 1 to 2 weeks after treatment.

RESULTS

The cure rate at 12 months was 45% (9/20) for group A, 60% (12/20) for group B and 80% (16/20) for group C. The mean difference in proportion cured at 12 months between group C and group A was 35 (7.0 to 66.8)%; P-value = .02. There was a statistically significant difference between cure rates over all follow-up of group C and A after adjustment for sex (adjusted OR = 3.09; 95%CI = 1.32-7.20; P-value = .009), but no significant difference was found between group B and A or C and B in the primary and/or secondary efficacy endpoints. Side effects from the treatment were found in 12% (7/60); 2 in group A, 4 in group B, and 1 in group C. Four of these were likely due to LiCO3 side effects.

CONCLUSIONS

Treatment of rapid turnover Graves' disease patients with high dose I-131 (7.4 MBq/g) provides significantly higher cure rates at 12 months, and 3 times odds of cure than 3.7 MBq/g I-131 plus LiCO3 with lesser side effects. We thus recommend 7.4 MBq I-131/g for treatment in these patients.

Lithium response in bipolar disorders and core clock genes expression

OBJECTIVES

We examine whether the lithium response is associated with changes in the expression of core clock genes.

METHODS

The effect of a therapeutic concentration of lithium (1 mM) on the expression levels of 17 circadian genes was examined in lymphoblastoid cell lines (LCLs) derived from two well-characterized groups of bipolar disorder patients, defined as lithium non-responders (NR, n = 20) or excellent responders (ER, n = 16). Quantitative real-time PCR (qRT-PCR) was conducted at 2, 4 and 8 days (d2, d4 and d8) with and without lithium exposure.

RESULTS

At d2, in ER only, BHLHE41, RORA, PER1, ARNTL, CRY2, BHLHE40 and CSNK1D were upregulated, whereas NR1D1 was downregulated. At d4, in ER only, CRY1 was downregulated. At d8, in NR only, GSK3β was upregulated and DBP, TIMELESS and CRY1 were downregulated. Significant Group × Lithium interactions existed for NR1D1 at d2 (P = 0.02), and CRY1 at d4 (P = 0.02). Longitudinal analyses showed differential temporal evolutions between NR and ER (significant Time × Group interaction) for PER3, NR1D1, DBP, RORA, CSNK1D and TIMELESS; and a significant Time × Lithium interaction for NR1D1. Coexpression data analyses suggested distinct groups of circadian genes concurrently modulated by lithium.

CONCLUSIONS

In LCLs, lithium influences expression of circadian genes with differences in amplitude and kinetics according to the patient's lithium response status.

Origin of Carbon Dioxide Evolved during Cycling of Nickel-Rich Layered NCM Cathodes

Gas formation caused by parasitic side reactions is one of the fundamental concerns in state-of-the-art lithium-ion batteries because gas bubbles might block local parts of the electrode surface, hindering lithium transport and leading to inhomogeneous current distributions. Here, we elucidate on the origin of CO₂, which is the dominant gaseous species associated with the layered lithium nickel cobalt manganese oxide (NCM) cathode, by implementing isotope labeling and electrolyte substitution in differential electrochemical mass spectrometry-differential electrochemical infrared spectroscopy measurements. Li₂CO₃ on the NCM surface was successfully labeled with ¹³C via a process that involves its removal followed by intentional growth. In situ gas analytics on such NCM samples with ¹³C-labeled Li₂CO₃ clearly indicate that Li₂CO₃ decomposition contributes to CO₂ evolution, especially during the first charge. At the same time, the greater contribution of electrolyte decomposition was indicated by the large amount of ¹²CO₂ observed. Employment of butyronitrile as the electrolyte solvent in further measurements helped determine that the majority of electrolyte decomposition occurs via a reaction that involves the lattice oxygen of NCM.

Effect of Lithium Preparations on Cerebral Electrophysiological Activity in Rats

The study examined the effects of a novel neurotropic medication based on a lithium complex composed of lithium citrate, polymethylsiloxane, and aluminum oxide on electrophysiological parameters of the rat brain. In contrast to lithium carbonate (the reference drug), the novel preparation resulted in a wave-like dynamics of electrical activity in the visual cortex. Rhythmic photic stimulation of the rats treated with lithium carbonate resulted in appearance of the signs attesting to up-regulation of excitability of cerebral cortex in all examined ranges. In contrast, the complex lithium preparation diminished the delta power spectrum, which was the only affected frequency band. It is hypothesized that the complex lithium medication induces milder activation of the cerebral cortex in comparison with lithium carbonate. The novel medication composed of lithium citrate, aluminum oxide, and polymethylsiloxane, is characterized by greater efficacy and safety than the preparation based on inorganic lithium salt (lithium carbonate).

Preoperative Preparation of Hyperthyroidism for Thyroidectomy - Role of Supersaturated Iodine and Lithium Carbonate

INTRODUCTION

Thyroidectomy is effective and safe procedure for permanent cure of hyperthyroidism (HT). Iodine preparations are widely used before operation to prevent excess blood loss. Ideal regimen for refractory HT is debated. This retrospective case-control study is designed to study the efficacy of various regimens of preoperative preparations.

MATERIALS AND METHODS

Case records, anesthesia charts, and follow-up details of hyperthyroid patients undergoing thyroidectomy were reviewed and compared with an age- and sex-matched euthyroid patients operated during the same period. Iodine preparations were not used for preoperative preparation. Study group was subdivided based on preoperative regimens of anti-thyroid medications.

RESULTS

Of the 168 patients in the study group, procedure time, duration of hospital stay, and overall complication rate were high compared to euthyroid group. Operative blood loss was not high in the study group. There was no difference in rate of complications in the subgroups of the study cohort.

CONCLUSION

Iodine preparations are not mandatory in preoperative preparation of HT. Lithium carbonate is effective in preoperative preparation of refractory HT. Rate of postthyroidectomy complications is not different in patients receiving thionamides alone or in combination with β-blocker.

Electrochemical Oxidation of Lithium Carbonate Generates Singlet Oxygen

Solid alkali metal carbonates are universal passivation layer components of intercalation battery materials and common side products in metal‐O₂ batteries, and are believed to form and decompose reversibly in metal‐O₂/CO₂ cells. In these cathodes, Li₂CO₃ decomposes to CO₂ when exposed to potentials above 3.8 V vs. Li/Li⁺. However, O₂ evolution, as would be expected according to the decomposition reaction 2 Li₂CO₃→4 Li⁺+4 e⁻+2 CO₂+O₂, is not detected. O atoms are thus unaccounted for, which was previously ascribed to unidentified parasitic reactions. Here, we show that highly reactive singlet oxygen (¹O₂) forms upon oxidizing Li₂CO₃ in an aprotic electrolyte and therefore does not evolve as O₂. These results have substantial implications for the long‐term cyclability of batteries: they underpin the importance of avoiding ¹O₂ in metal‐O₂ batteries, question the possibility of a reversible metal‐O₂/CO₂ battery based on a carbonate discharge product, and help explain the interfacial reactivity of transition‐metal cathodes with residual Li₂CO₃.

Lithium as a prooxidant? A possible protective role of selenium - in vitro study

INTRODUCTION AND OBJECTIVE

Lithium is used in medicine but its application may cause diverse side effects. Selenium has been found to show protective properties against negative influence of different harmful factors. This study was aimed at evaluating the influence of non-toxic dose of lithium on antioxidant parameters in FaDu (ATCC HTB-43) and Vero (ECACC No. 84113001) cell lines as well as the possible protective effect of non-toxic concentration of sodium selenite.

MATERIAL AND METHODS

The cells were subjected to 0.17 mmol/L of Li₂CO₃ and/or 2.9 µmol/L of Na₂SeO₃ · 5H₂O for Vero as well as 0.47 mmol/L of Li₂CO₃ and/or 3.0 µmol/L of Na₂SeO₃ · 5H₂O for FaDu cells. The incubation was continued for the subsequent 72 h. In the cells total antioxidant status (TAS) values, activities of antioxidant enzymes - superoxide dismutase (SOD) and glutathione peroxidase (GPx) as well as the reduced glutathione concentration (GSH) were determined.

RESULTS AND CONCLUSION

In Vero cells lithium decreased all studied parameters, particularly GPx. Selenium co-treatment showed a distinct protective effect. In FaDu cells the similar effect was observed only in case of GSH. The results point to differences in action of lithium and selenium in physiological and pathological state. As long-term lithium therapy is applied in psychiatric patients the results regarding Vero line let suggest that selenium might be considered as an adjuvant alleviating side effects of Li-treatment.

[Profile of lithium carbonate use in patients with bipolar disorder in Colombia]

INTRODUCTION

Lithium is the drug of choice for the treatment of bipolar affective disorder.

OBJECTIVE

To define lithium therapeutic profile and adverse reactions to its use in patients with bipolar affective disorder in Colombia.

MATERIALS AND METHODS

We conducted an observational retrospective cohort study between January 1 and December 31, 2013, which included patients with a diagnosis of bipolar disorder treated with lithium carbonate in 25 Colombian cities; we evaluated socio-demographic variables, lithium dose, co-medication, drug interactions and adverse reactions. A multivariate analysis was done using SPSS 22.0.

RESULTS

The 331 patients had an average age of 44.5 ± 13.9 years; 59.2% were women. The mean dose of lithium was 898 ± 294 mg/day; 22% received doses lower than recommended, and patients had received lithium for 38.0 ± 39.5 months (range: 12-159 months). Lithium levels in blood had been measured only in 13.5% of patients; 71.3% of them had received adjuvant therapy for bipolar disorder with other drugs, especially clozapine (16.6%) and valproic acid (16.6%). The main comorbidities were hypothyroidism (18.1%) and hypertension (12.7%); 390 potentially toxic drug interactions were found, and adverse reactions were reported in 1.2% of patients. A statistically significant association was found between a lower risk of combination therapy and receiving treatment in the cities of Bogotá (OR=0.4, p=0.025), Cartagena (OR=0.3, p=0.015) and Ibagué (OR=0.3, p=0.025).

CONCLUSION

Lithium was generally used at recommended doses and intervals, but a significant percentage of patients received lower doses than those recommended, and it was not possible to compare with lithium levels in blood. Adverse reactions and blood lithium levels reporting should be improved in patients with bipolar disorder in Colombia.

Differences in body mass index according to fat mass- and obesity-associated (FTO) genotype in Mexican patients with bipolar disorder

OBJECTIVES

The prevalence of obesity has dramatically increased in many countries and it is particularly high in patients with bipolar disorder (BD). A region in the first intron of the fat mass- and obesity-associated (FTO) gene, encompassing markers rs9939973, rs8050136, and rs9939609, has been consistently associated with obesity and body mass index (BMI) in different populations. We sought to determine whether FTO is associated with BMI and/or obesity in patients with BD.

METHODS

The sample included 129 Mexican Mestizo patients with bipolar I or bipolar II disorder. After obtaining informed consent, participants were evaluated with the Structured Clinical Interview for DSM-IV Axis I Disorders and weight, height, and body measurements were recorded. DNA was extracted from a 5-mL blood sample and real-time polymerase chain reaction was performed. The results were analyzed with Haploview v4.2 and SPSS v21.

RESULTS

Differences in mean BMI were explained by rs8050136 and rs9939609 genotypes, especially by comparing non-carriers and carriers of two copies of the risk allele (Tukey's p ≤ 0.019), with a mean difference in BMI as high as 7.81 kg/m(2) . Differences in BMI were also explained by the interaction of the genotype (rs8050136 and/or rs9939609), the use of second-generation antipsychotics, and the use of mood stabilizers (p ≤ 0.41). Obesity was also associated with these two markers when patients with and without obesity were compared.

CONCLUSIONS

In patients with BD, differences in BMI may be affected by the presence of FTO risk alleles, especially in homozygous individuals for these variants. Besides evaluating the possible metabolic effects of certain antipsychotics or mood stabilizers, it is important to evaluate the role of other factors such as FTO risk alleles.

Neuroleptic malignant syndrome in a patient treated with lithium carbonate and haloperidol

A 39-year-old female with a 20-year history of bipolar disorder was admitted due to a recurrence of a manic episode with psychotic symptoms. She was treated with standard doses of lithium carbonate and clozapine. Three days after admission, she showed aggressive behavior and refused to take her medications so her oral clozapine was switched to intramuscular haloperidol. Three days later she developed a high temperature and exhibited symptoms of neuroleptic malignant syndrome (NMS) including excessive sweating, cramps and tremors in limb muscles, muscle rigidity, and impaired consciousness. The haloperidol and lithium were stopped immediately, symptomatic treatment was provided, and she was administered the dopamine agonist bromocriptine. The NMS symptoms resolved within three days but she continued to have severe psychotic symptoms. She was subsequently re-challenged with valproate and olanzapine but the NMS did not re-occur. After one month of this treatment she recovered and was discharged. Several case histories similar to this one suggest – but do not prove – that individuals concurrently receiving lithium and antipsychotic medications may be at higher risk of developing NMS than those receiving monotherapy with antipsychotic medication.

Psychiatric agents and implications for perioperative analgesia

The use of antidepressants, anxiolytics, mood stabilizers, anticonvulsants, and major tranquilizers introduces neurochemical, behavioral, cognitive, and emotional factors that increase the complexity of medical and surgical tasks. Increasingly, various classes of psychotropic medications are being prescribed in the perioperative setting for their analgesic properties in patients with or without a psychiatric diagnosis. In many cases, the precise mechanisms of action and dose-response relationships by which these agents mediate analgesia are largely unclear. An appreciation of the side effects and adverse-effect profiles of such medications and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in dealing with patients on these medications. This review focuses on various classes of psychotropic agents, which are addressed individually, with particular focus on their analgesic properties. The latest published research is summarized, deficiencies in our current collective knowledge are discussed, and evidence-based recommendations are made for clinical practice.

Aspirin for treatment of lithium-associated sexual dysfunction in men: randomized double-blind placebo-controlled study

OBJECTIVES

The aim of the present study was to assess the effect of aspirin on lithium-related sexual dysfunction in men with stable bipolar affective disorder (BAD).

METHODS

In a randomized, double-blind, placebo-controlled study, 32 men with stable BAD who had been on lithium maintenance therapy randomly received aspirin (240 mg/day) or placebo for six weeks. The International Index for Erectile Function (IIEF) was used to assess sexual symptoms at baseline, Week 3, and Week 6. Depressive and mania symptoms and plasma lithium concentrations were assessed at baseline and Week 6. Side effects were assessed using a checklist.

RESULTS

Thirty patients (15/group) completed the study. Baseline and endpoint lithium concentrations and mania and depressive symptoms did not differ significantly between the two groups. Significant effects of time × treatment interaction were observed for total score [Greenhouse-Geisser: F(1.410,39.466) = 6.084, p = 0.010] and erectile function [Greenhouse-Geisser: F(1.629,45.602) = 7.250, p = 0.003]. By Week 6, patients in the aspirin group showed significantly greater improvement in the total (63.9% improvement from the baseline) and erectile function domain (85.4% improvement from the baseline) scores than the placebo group (14.4% and 19.7% improvement from the baseline, p-values = 0.002 and 0.001, respectively). By Week 6, 12 (80%) patients in the aspirin group and three (20%) patients in the placebo group met the criteria of minimal clinically important change [χ(2) (1) = 10.800, p = 0.001]. Other IIEF domains also showed significant improvement at the end of the trial. The frequency of side effects was similar between the two groups.

CONCLUSION

Aspirin effectively improves lithium-related sexual dysfunction in men with stable BAD.