Effects of adding hypertonic saline solutions and/or etilefrine to standard diuretics therapy in cirrhotic patients with ascites

OBJECTIVE

The renin-angiotensin-aldosterone system (RAAS) activation is the milestone in ascites formation. Hypertonic saline solution (HSS) has attracted considerable interest over the last years in ascites control. Other therapeutic models and concepts have been introduced to overcome diuretic resistance and control ascites. We aimed to evaluate the effects of adding HSS infusion and/or etilefrine to oral diuretics therapy on inflammatory and metabolic pathways, renal and systemic hemodynamics, and clinical outcomes by estimating the changes in selected biochemical and biological markers in cirrhotic patients with ascites.

PATIENTS AND METHODS

Ninety cirrhotic patients with ascites were studied after administration of HSS infusion (n=25) or etilefrine tablets (n=25), or both (n=25) plus standard diuretics therapy (SDT), or SDT alone (n=15). Serum levels of interleukin-6 (IL-6), aldosterone, leptin, and C-reactive protein (CRP). Hepatic and renal functions were measured at baseline, after eight days, then after 38 days.

RESULTS

A significant reduction in serum IL-6, serum aldosterone, Child-Pugh score, MELD-Na score, and increase in serum leptin, and mean arterial pressure (p<0.05) were noted after 38 days in HSS and combination groups. A significant improvement in diuresis, in all groups, urinary sodium excretion, and creatinine clearance (p<0.05) were increased after 38 days in all groups except the SDT group.

CONCLUSIONS

The results suggest that HSS, etilefrine, and their combination plus SDT are superior to SDT alone for ascites control and can exert some benefits on clinical, systemic, inflammatory, renal, and metabolic pathways without renal or hepatic dysfunction.

Neutron-induced mass shift of tin isotopes recognized using inductively coupled plasma mass spectrometry as an isotopic fingerprint on neutron reactions

The phenomenon of isotope shift in response to neutron irradiation was investigated. The high fission-neutron fluence of 1.44×10¹⁸ cm^-2 from the second Egyptian research reactor (ETRR-2) was used to induce a mass shift in a metallic tin sample. A triple-quadrupole inductively coupled plasma mass spectrometry system was used to analyze the isotope abundances in the mass range from A=111 to A=125. The problem of mass bias due to kinetic fractionation on use of the inductively coupled plasma mass spectrometry system was treated by our calibrating the mass bias with a standard reference tin solution and building a response function. The response function was used to obtain absolute abundances in each mass range instead of isotope ratios. The results show that the mass shifts in the irradiated sample are dependent on the cross section of the neutron capture reaction in the tin isotopes.

MiR302c, Sp1, and NFATc2 regulate interleukin-21 expression in human CD4+CD45RO+ T lymphocytes

Interleukin-21 (IL-21) is a cytokine with potent regulatory effects on different immune cells. Recently, IL-21 has been contemplated for use in the treatment of cancers. However, the molecular mechanisms regulating human IL-21 gene expression has not yet been described. In this study, we initially studied the promoter region and identified the transcription start site. We thereafter described the essential region upstream of the transcription start site and showed the in vivo binding of NFATc2 and SP1 transcription factors to this region, in addition to their positive role in IL-21 expression. We also studied the role of microRNAs (miRNAs) in regulating IL-21 expression. We, thus, established the miRNA profile of CD4+CD45RO+ versus CD4+CD45RA+ isolated from healthy volunteers and identified a signature composed of 12 differentially expressed miRNAs. We showed that miR-302c is able to negatively regulate IL-21 expression by binding directly to its target site in the 3'-untranslated region. Moreover, after using fresh human CD4-positive T cells, we observed the high acetylation level of histone H4, an observation well in line with the already described high expression of IL-21 in CD4+CD45RO+ versus CD4+CD45RA+ T cells. Altogether, our data identified different molecular mechanisms regulating IL-21 expression.

99Mo/99mTc radioisotope generator based on adsorption of 99Mo (VI) on cerium (IV) molybdate column matrix

Based on neutron activated 99Mo, a procedure for preparation of 99Mo/99mTc radioisotope generator was developed. Batch equilibration method was used to investigate the sorption behavior of Mo (VI) (10−4 M) in chloride and nitrate solutions on cerium (IV) molybdate gel matrix using 99Mo radiotracer. The breakthrough sorption capacity of cerium molybdate gel matrix for 99Mo (VI) (3×10−2 M) were found to be 0.54 mmol/g of the sorbent [1 g column (0.6 cm i.d.)]. Elution performance of the generated 99mTc from cerium molybdate-99Mo chromatographic column was investigated as a function of inside diameter of the column, amount of the bed matrix and flow rate of the eluent. Based on the obtained results, 99Mo/99mTc radioisotope generator was prepared based on adsorption of neutron activated 99Mo (VI) of low specific activity onto chromatographic columns packed with 5 g cerium molybdate gel matrix. The radioactivity of 99mTc is periodically eluted with 10 mL 0.9% NaCl solution at a flow rate of 1 mL/min. Elution yield of 78±5% was obtained with high chemical, radionuclidic (99Mo breakthrough 1×10−3±0.3×10−3%) and radiochemical purity (97±2%).

Preparation and characterization of zirconium silico188W-tungstate as a base material for 188W/188Re generator

Zr:W:Si. The optimum gel was prepared using the molar ratio 1:1:7 at pH 8. The ZrSiW gel was investigated by FTIR, XRD, thermal analysis (TGA and DTA), FESEM, XRF, and NAA. Then, XRF and NAA techniques were used to estimate the proportion of the constituents of the gel according to the molecular formula [ZrO₂(Si(WO₄)₂)16H₂O]. ¹⁸⁸W/¹⁸⁸Re generator was prepared based on the selected ZrSi¹⁸⁸W gel, which gives the highest tungsten content (393.3 mg W/g gel) with 75 ± 3% elution yield of ¹⁸⁸Re. Quality control was studied on the ¹⁸⁸Re to make sure its validity for clinical applications.

Development of granular radioactive reference source from 152,154Eu adsorbed on tin tungstate matrix

A reference source with the granular active portion was made using 152,154Eu(III) loaded tin tungstate material. Batch equilibration method was used to investigate the interaction of 152,154Eu(III) radiotracer (10−4 M) in acid solutions on tin(IV) tungstate gel matrix. The sorption behavior of 152,154Eu(III) showed high affinity towards tin(IV) tungstate gel matrix at low pH values. Tin tungstate gel matrix was loaded with 152,154Eu from batch at pH 3. Standardization of the source was done spectroscopically with reference to primary certified set of radioactive sources and with the aid of HPGe detector. Random and true coincidence summing was carried out by following-up coincidence in 152Eu and possible interference between γ lines of 152Eu and 154Eu. The relation between the grain size and the activity of samples was studied. Correction factor for capsule attenuation was applied.