Intravenous Infusion Of Saline Research Articles

Effects of intravenous tryptophan infusion on thermoregulation in steers exposed to acute heat stress.

This study was conducted to investigate the effect of tryptophan (TRP) supply on the thermoregulatory responses via brain serotonin (5-HT) in cattle. In period 1, 12 Holstein steers were kept under a constant room temperature (22°C) and were administered the intravenous (i.v.) infusion of saline or TRP (38.5mg/kg/2h). Changes in rectal temperature (RT), 5-HT concentration in the cerebrospinal fluid (CSF), and other factors involved in thermoregulation were measured. In period 2, the steers received the same treatments as in period 1; however, the room temperature was elevated from 22°C to 33°C during i.v. infusion and maintained at 33°C for 3h. 5-HT concentration in CSF increased following TRP infusion in both periods, and RT significantly decreased following TRP infusion only in period 2. The effect of TRP on respiration rate and plasma prolactin and total triiodothyronine concentrations was not significant. These results suggest that increase in TRP supply can attenuate increase in RT in response to acute heat stress through the increase in brain 5-HT, followed by presumable increase in evaporative heat loss from the skin surface in cattle. It is possible that the increase in peripheral blood TRP metabolites could also participate in the hypothermic effect of TRP.

2 Cases of Acute Confusional State with Autonomic Symptoms after Designer Tryptamine Abuse

We herein report 2 cases of acute tryptamine abuse. Both cases developed confusional state within 1 hour of 4- acetoxy-N-methyl-N-isopropyl-tryptamine ingestion. On admission, they presented confusion with marked mydriasis. In addition, one case showed hypertension, low grade fever, and hyperhidrosis, and the other showed the contraction of pilomotor muscles. Confusion and other autonomic symptoms improved gradually with intravenous drip infusion of saline. Tryptamine abuse should be considered as differential diagnosis in cases of acute confusional state with various autonomic symptoms.

Emergency Response of Indian Hajj Medical Missionto Heat Illness Among Indian Pilgrims in Tent-Clinics atMina and Arafat During Hajj, 2016

Introduction: Extreme heat claims more lives than all other weather-related exposures combined. Hajj rituals at Mina, Arafat, and Muzdalifah involve a minimally-clothed, moving assemblage of 3.5 million pilgrims who are exposed to a harsh, hot, desert climate during physically challenging outdoor rituals and unsheltered night stays, rendering them prone to heat illness, dehydration, and sunburn. This cross-sectional study assessed the emergency response of the Indian Hajj Medical Mission to overwhelming heat illnesses in Mina and Arafat among Indian pilgrims during Hajj, 2016. Methods: In 2016, 88 patients affected by the heat were brought to central tent-clinics at 36 maktabs in Mina and Arafat that were established by the Indian Hajj Medical Mission. Patients were offered rapid external evaporative cooling (wet towels) and cold intravenous saline infusion on patient couches and wheelchairs. Results: The incidence of heat illness among Indian pilgrims in 2016 was 0.62/1000. The ratio of males to females was 1.8:1. Mean ages of males and females were 62.2 ± 7.43 and 52.6 ± 9.3, respectively. Pre-existing conditions, such as diabetes mellitus and hypertension, were present in 93.2% of the patients. The most common presentations included hyperthermia, fatigue, and restlessness. Heatstroke presented in five patients and resulted in one fatality. Twenty-eight patients were referred to Saudi hospitals, and 12 of them were institutionalized. Exertion related to the stoning of Satan ritual during late morning and afternoon hours was the leading cause of heat illness. Conclusion: The overwhelming incidence of heat illness among Indian pilgrims in the critical five-day period of the Hajj represents the tip of the iceberg as the Hajj attracts over 3.5 million pilgrims from 200 countries annually. Heat illness is difficult to manage in the presence of pre-existing comorbidities and mandates clientele education and outreach warning systems to enhance resilience capital amongst Hajj pilgrims, sportspersons, outdoor enthusiasts, and military personnel.

Analysis of the clinical value of sufentanil combined with propofol in the treatment of anesthesia in children

Objective To explore the clinical value of combined treatment of sufentanil and propofol in children during anesthesia induction. Methods 72 children were selected, and they were randomly divided into three groups by full random allocation method: observation group A, observation group B and control group, 24 cases in each group.The observation group A was given intravenous infusion of sufentanil(0.01g·kg-1·min-1), the observation group B was given intravenous infusion of sufentanil (0.02g·kg-1·min-1), the control group was given intravenous saline infusion, then given propofol target controlled infusion after 30min.The bispectral index (BIS), propofol effect chamber (EC), OAA/S score and time of induction of anesthesia (LOC) time were recorded in the three groups. Results There was a significant correlation between BIS and propofol EC and OAA/S scores in the three groups, and there was a negative correlation between BIS and propofol EC (r=-0.82, -0.79, -0.88, all P 0.05]. The BIS of observation group B (78±5) was significantly higher than that of the observation group A and control group (t=6.12, 5.13, all P<0.01). Conclusion Sufentanil combined with propofol for anesthesia in children has a synergistic effect, which is beneficial to reduce the amount of propofol EC during anesthesia induction, shorten the time of LOC and enhance the sedative effect of propofol, and it is worthy of further clinical application. Key words: Sufentanil; Propofol; Anesthesia inductio; Child

Inverse correlation between left ventricular end-diastolic pressure and contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.

There is a rising incidence of contrast-induced nephropathy (CIN), which is defined as either a 25% relative increase or an absolute increase of 0.5mg/dL (44.2µmol/L) in the serum creatinine (Scr) level at 48-72h after administration of iodinated contrast media (CM). We investigated the relationship between left ventricular end-diastolic pressure (LVEDP) and CIN in patients undergoing percutaneous coronary intervention (PCI). A total of 431 consecutive patients with coronary artery disease undergoing PCI were divided into four groups based on LVEDP quartile cut-off points. Enrolled patients were given continuous intravenous infusion of normal saline starting 4h before PCI and lasting 24h. At the end of hydration administration, 20mg furosemide was slowly injected intravenously. Serum creatinine (Scr), creatinine clearance rate (Ccr), and glomerular filtration rate (GFR) were detected before and after PCI. There were significant differences in the incidences of CIN in the four groups: 10.25% in the Q1 group, 5.55% in the Q2 group, 5.31% in the Q3 group, and 1.06% in the Q4 group (P < 0.05). With increasing LVEDP, the incidence of CIN decreased significantly (OR 0.581, 95% CI 0.367-0.920). Received operating characteristic curve analysis of the predictive value of LVEDP for CIN produced area under the curve values was 0.641, with a sensitivity of 74.1% and specificity of 48%. The optimal LVEDP cut-off for the occurrence of CIN was 14.5mmHg. LVEDP correlated inversely with CIN in patients undergoing PCI.

Abstract 23088: GLP-1 Loading During Percutaneous Coronary Intervention (GOLD PCI) trial

Introduction: Glucagon-like peptide 1 (7-36) amide (GLP-1) is an incretin hormone, which has been shown to protect against non-lethal cardiac ischemia-reperfusion injury. We sought to investigate whether GLP-1 protected against PCI-induced myocardial infarction (PMI) and attenuate cardiac troponin I (cTnI) release after elective PCI. Methods: A double-blind, randomised, placebo-control trial, stratified for diabetes mellitus, conducted in a single UK centre, administered an intravenous infusion of GLP-1 (1.2pmol/Kg/min) or saline to patients approximately 30-minutes before elective PCI. The primary endpoint was PMI defined as a cTnI elevation &gt; 5xURL at 6-hours post-PCI. Secondary endpoints include, intra-procedural chest pain, TIMI flow and blush grade after PCI, rise in cTnI elevation and creatinine at 6-hours post-PCI and major adverse cardiovascular and cerebrovascular events (MACCE) at six months. Results: A CONSORT diagram for the study is shown in Figure 1. Of the 192 patients randomized, 152 (79%) were male, mean age 68.1±8.9 years. Patient demographics were similar between the groups. There was no inter-group difference in the incidence of PMI: GLP-1 9 (9.8%) vs. saline 8 (8.3%), p=0.28. Median [IQR] cTnI elevation between the groups was also similar: GLP-1 20 [0-88.5] vs. saline 10 [0-58.5] ng/L, p=0.28. Renal function was not impaired at 6 hours. Δ Creatinine was not significantly different. (GLP-1 -2.78±9.04 vs. saline -1.75±8.74 μmol/L, p=0.73). Other secondary end-point data will be available at time of presentation. Conclusion: GLP-1 did not confer cardioprotection against PMI after elective PCI, although the incidence of PMI in contemporary PCI is low.

Effect of hormonal and energy-related factors on plasma adiponectin in transition dairy cows

In transition dairy cows, plasma levels of the insulin-sensitizing hormone adiponectin fall to a nadir at parturition and recover in early lactation. The transition period is also characterized by rapid changes in metabolic and hormonal factors implicated in other species as positive regulators of adiponectin production (i.e., negative energy balance, lipid mobilization) and others as negative regulators (i.e., reduced leptin and insulin and increased growth hormone and plasma fatty acids). To assess the role of onset of negative energy balance and lipid mobilization after parturition, dairy cows were either milked thrice daily (lactating) or never milked (nonlactating) for up to 4 wk after parturition. Plasma adiponectin was 21% higher across time in nonlactating than lactating cows. Moreover, nonlactating cows recovered plasma adiponectin at similar rates as lactating cows even though they failed to lose body condition. Next, we assessed the ability of individual hormones to alter plasma adiponectin in transition dairy cows. In the first experiment, dairy cows received a constant 96-h intravenous infusion of either saline or recombinant human leptin starting on d 8 of lactation. In the second experiment, dairy cows were studied in late pregnancy (LP, starting on prepartum d -31) and again in early lactation (EL, starting on d 7 postpartum) during a 66-h period of basal sampling followed by 48 h of hyperinsulinemic-euglycemia. In the third experiment, cows were studied either in LP (starting on d -40 prepartum) or EL (starting on d 7 postpartum) during a 3-h period of basal sampling followed by 5 d of bovine somatotropin treatment. Plasma adiponectin was reduced by an average of 21% in EL relative to LP in these experiments, but neither leptin, insulin, or growth hormone treatment affected adiponectin in LP or EL. Finally, the possibility that plasma fatty acids repress plasma adiponectin was evaluated by intravenous infusion of a lipid emulsion in nonpregnant, nonlactating cows in the absence or presence of glucagon for 16 consecutive hours. The intralipid infusion increased plasma fatty acid concentration from 102 to over 570 µM within 3 h but had no effect on plasma adiponectin irrespective of presence or absence of glucagon. Overall, these data suggest that energy balance around parturition may regulate plasma adiponectin but do not support roles for lipid mobilization or sustained changes in the plasma concentration of leptin, insulin, growth hormone, or fatty acids.

Effect of HA330 resin-directed hemoadsorption on a porcine acute respiratory distress syndrome model

BackgroundBlood purification is an emerging approach to dampening the cytokine storm. This study aims to assess the efficacy of HA330 resin-directed hemoadsorption (HA) on endotoxin-induced porcine acute respiratory distress syndrome (ARDS) model.MethodsTwenty-four Chinese domestic pigs were allocated into saline group receiving intravenous infusion of saline (N = 6) and endotoxin group receiving intravenous infusion of LPS (N = 18). When ALI model was initially diagnosed, six pigs in the LPS and saline group were killed for BALF and histopathological analysis. The remaining 12 pigs in LPS group received 3-h HA (N = 6) or HA-sham (N = 6) treatment, respectively. Following another 5-h observation, animals were killed. Variables on hemodynamics, blood gases and lung mechanics were recorded at a series of time points. Differentially expressed cytokines and proteins were determined by ELISA and proteomics.ResultsHA treatment significantly improved injured oxygenation induced by LPS. HA also partially improved the barrier permeability and reduced lung edema and inflammation/injury induced by LPS infusion. Proteomic analysis showed the differentially expressed proteins between HA- and HA-sham-treated groups mostly belonged to the categories of acute inflammation/immune response, and proteolysis.ConclusionsHemoadsorption improved ARDS possibly by blunting the cytokine storm and by restoring homeostasis of the disordered proteome milieu in the exudative phase.

IMMUNE CELL PROFILE OF DENTAL PULP IN RATS TREATED WITH ZOLEDRONIC ACID

The objective of this study was to characterize the pulp immune cell profile in the teeth of rats treated with Zoledronic Acid (ZA). For this Male Wistar rats (n=6) received 4 intravenous infusions of ZA (0.04, 0.20 or 1.00 mg/kg) or saline. In the 70th day, they were euthanized. The first right molar was microscopically examined (H&E, toluidine blue and immunohistochemistry for CD68, Tumor Necrosis Factor (TNF)-α, Interleukin(IL)-1β, Inducible Nitric Oxide Synthase (iNOS), Nuclear Factor kappa B (NFkB) and IL-18 binding protein (IL-18bp). Were analyzed the ectasic/dilated vessels, the inflammatory cells (mast cells and mononuclear CD68 positive cells) and intensity of immunostaining for inflammatory markers in odontoblasts and non-odontoblasts pulp cells. Were used the Kruskall-Wallis/Dunn's and the chi-square tests (P<.05). There is no differences in number of animals exhibiting dilated/ectasia blood vessels (P=.242), inflammatory cells (P=.489) and in the number of mast cells (P=1.000). However, there was an augment of CD68 positive cells (P=.026), immunostaining of TNF-α (P=.020), IL-1β (P=.027), iNOS (P=.001) in odontoblasts and IL-1β (P=.027) in non-odontoblasts pulp cells dose-dependently. NFkB (nucleus and cytoplasm) and IL-18bp did not differ between groups. It was showed that ZA modified the immune cell profile in the dental pulp independent of NFkB.

Effect of Normal Saline Infusion versus Dextrose 5% Infusion on the Duration of Labor in Nulliparous Women : Randomized Controlled Trial

Background: During labor, it is common for women to have no or little nutrient intake, inspite of the fact that the demand of energy increases as a result of skeletal and smooth muscle contraction. Aim of the Work: This study aims to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion in acceleration of active phase of labor in nulliparous women. Patients and Methods: Thisprospective randomized controlled trial was conducted on nulligravida patients recruited from those attending labor ward of Ain Shams University, Maternity hospital who are, singleton gestation, 36 weeks or more. Results: Total duration of first and second stages of laborwas significantly shorter among Dextrose 5% group than among Normal saline group. Conclusion: Dextrose 5% solution administration is associated with shortened duration of labor because it provides the required energy for pregnant mothers during the labor procedure through the detraction of harmful metabolites produced together with ATP production and results in acceleration of the labor process. Recommendations: Dextrose 5% administration during labor is associated with shortened duration of labor. Further studies with larger sample sizes, more outcomes and different dextrose concentration is required to determine the exact effect of dextrose.

Peroxisome proliferator-activated receptor γ agonism attenuates endotoxaemia-induced muscle protein loss and lactate accumulation in rats.

The peroxisome proliferator-activated receptor γ (PPARγ) agonist rosiglitazone (Rosi) appears to provide protection against organ dysfunction during endotoxaemia. We examined the potential benefits of Rosi on skeletal muscle protein maintenance and carbohydrate metabolism during lipopolysaccharide (LPS)-induced endotoxaemia. Sprague-Dawley rats were fed either standard chow (control) or standard chow containing Rosi (8.5 ± 0.1 mg·kg-1·day-1) for 2 weeks before and during 24 h continuous intravenous infusion of LPS (15 μg·kg-1·h-1) or saline. Rosi blunted LPS-induced increases in muscle tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) mRNA by 70% (P<0.05) and 64% (P<0.01) respectively. Furthermore, Rosi suppressed the LPS-induced reduction in phosphorylated AKT and phosphorylated Forkhead box O (FOXO) 1 protein, as well as the up-regulation of muscle RING finger 1 (MuRF1; P<0.01) mRNA and the LPS-induced increase in 20S proteasome activity (P<0.05). Accordingly, LPS reduced the muscle protein:DNA ratio (∼30%, P<0.001), which Rosi offset. Increased muscle pyruvate dehydrogenase kinase 4 (PDK4) mRNA (P<0.001) and muscle lactate accumulation (P<0.001) during endotoxaemia were suppressed by Rosi. Thus, pre-treatment with Rosi reduced muscle cytokine accumulation and blunted muscle protein loss and lactate accumulation during endotoxaemia, and at least in part by reducing activation of molecular events known to increase muscle protein breakdown and mitochondrial pyruvate use.

Effects of dexmedetomidine on CD42a+/CD14+, HLADR+/CD14+ and inflammatory cytokine levels in patients undergoing multilevel spinal fusion

Objective: To assess the effects of dexmedetomidine (Dex) on CD42a+/CD14+，HLADR+/CD14+ and inflammatory cytokine levels in patients undergoing multilevel spinal fusion. Patients and methods Forty ASA I–II patients undergoing multilevel spinal fusion were randomly divided into Dex and control groups (n=20). A continuous intravenous infusion of Dex (0.5μg/kg/h) or normal saline was started 10min prior to induction and was stopped 15min before operation completion. Serum levels of CD42a+/CD14+, HLADR+/CD14+, WBC, PLT, CRP, IL-6, IL-10, and TNF-α were measured before induction (T1), 30min (T2) after operation initiation, and 60min (T3), 1d (T4), 3d (T5), and 5d (T6) post-operation. VAS values were obtained at T3, T4, T5 and T6, as well as hospital days. Results: Treatment with Dex significantly decreased CD42a+/CD14+ at T2, T3, and T4, and markedly increased HLADR+/CD14+ at T4 and T5 when compared with controls. CRP and WBC were markedly decreased at T2, T3, T4 and T5 (P<0.01 or P<0.05). Serum IL-6 and TNF-α level in Dex group was significantly increased at T3 and T4 (P<0.05), and IL-6 and TNF-α level in control group was significantly increased at T2, T3, T4 and T5 (P<0.05) when compared with their respective preoperative levels (T1). IL-6 and TNF-α levels at T2, T3, T4 and T5 in Dex group were significantly lower than those in control group (P<0.05). There were no significant differences in operation time, hospital days or VAS values between the two groups (P>0.05). Conclusion: Dex can inhibit the inflammatory response and reduce immunosuppression in patients undergoing multilevel spinal fusion.

Beta-1 vs. beta-2 adrenergic control of coronary blood flow during isometric handgrip exercise in humans.

During exercise, β-adrenergic receptors are activated throughout the body. In healthy humans, the net effect of β-adrenergic stimulation is an increase in coronary blood flow. However, the role of vascular β1 vs. β2 receptors in coronary exercise hyperemia is not clear. In this study, we simultaneously measured noninvasive indexes of myocardial oxygen supply (i.e., blood velocity in the left anterior descending coronary artery; Doppler echocardiography) and demand [i.e., rate pressure product (RPP) = heart rate × systolic blood pressure) and tested the hypothesis that β1 blockade with esmolol improves coronary exercise hyperemia compared with nonselective β-blockade with propranolol. Eight healthy young men received intravenous infusions of esmolol, propranolol, and saline on three separate days in a single-blind, randomized, crossover design. During each infusion, subjects performed isometric handgrip exercise until fatigue. Blood pressure, heart rate, and coronary blood velocity (CBV) were measured continuously, and RPP was calculated. Changes in parameters from baseline were compared with paired t-tests. Esmolol (Δ = 3296 ± 1204) and propranolol (Δ = 2997 ± 699) caused similar reductions in peak RPP compared with saline (Δ = 5384 ± 1865). In support of our hypothesis, ΔCBV with esmolol was significantly greater than with propranolol (7.3 ± 2.4 vs. 4.5 ± 1.6 cm/s; P = 0.002). This effect was also evident when normalizing ΔCBV to ΔRPP. In summary, not only does selective β1 blockade reduce myocardial oxygen demand during exercise, but it also unveils β2-receptor-mediated coronary exercise hyperemia.NEW & NOTEWORTHY In this study, we evaluated the role of vascular β1 vs. β2 receptors in coronary exercise hyperemia in a single-blind, randomized, crossover study in healthy men. In response to isometric handgrip exercise, blood flow velocity in the left anterior descending coronary artery was significantly greater with esmolol compared with propranolol. These findings increase our understanding of the individual and combined roles of coronary β1 and β2 adrenergic receptors in humans.

Low-dose suramin in autism spectrum disorder: a small, phase I/II, randomized clinical trial.

ObjectiveNo drug is yet approved to treat the core symptoms of autism spectrum disorder (ASD). Low‐dose suramin was effective in the maternal immune activation and Fragile X mouse models of ASD. The Suramin Autism Treatment‐1 (SAT‐1) trial was a double‐blind, placebo‐controlled, translational pilot study to examine the safety and activity of low‐dose suramin in children with ASD.MethodsTen male subjects with ASD, ages 5–14 years, were matched by age, IQ, and autism severity into five pairs, then randomized to receive a single, intravenous infusion of suramin (20 mg/kg) or saline. The primary outcomes were ADOS‐2 comparison scores and Expressive One‐Word Picture Vocabulary Test (EOWPVT). Secondary outcomes were the aberrant behavior checklist, autism treatment evaluation checklist, repetitive behavior questionnaire, and clinical global impression questionnaire.ResultsBlood levels of suramin were 12 ± 1.5 μmol/L (mean ± SD) at 2 days and 1.5 ± 0.5 μmol/L after 6 weeks. The terminal half‐life was 14.7 ± 0.7 days. A self‐limited, asymptomatic rash was seen, but there were no serious adverse events. ADOS‐2 comparison scores improved by −1.6 ± 0.55 points (n = 5; 95% CI = −2.3 to −0.9; Cohen's d = 2.9; P = 0.0028) in the suramin group and did not change in the placebo group. EOWPVT scores did not change. Secondary outcomes also showed improvements in language, social interaction, and decreased restricted or repetitive behaviors.InterpretationThe safety and activity of low‐dose suramin showed promise as a novel approach to treatment of ASD in this small study.

Tranexamic Acid Reduces Occult Blood Loss, Blood Transfusion, and Improves Recovery of Knee Function after Total Knee Arthroplasty: A Comparative Study.

This study intends to explore the effects of tranexamic acid (TA) on occult blood loss, blood transfusion, and recovery of knee function in patients undergoing total knee arthroplasty (TKA). From October 2013 to April 2015, 224 patients undergoing TKA were enrolled in this study. These patients were randomly assigned into the control group (intravenous infusion of normal saline), 10 mg/kg TA group (intravenous infusion of 10 mg/kg TA) and 15 mg/kg TA group (intravenous infusion of 15 mg/kg TA). Compared with the control group, the 10 and 15 mg/kg TA groups were lower in postoperative blood loss, occult blood loss, blood transfusion rate, and volume. In comparison to the control group, hemoglobin levels were lower and the number of red blood cells was higher at 7 days after surgery in the 10 and 15 mg/kg TA groups. Higher fibrinogen levels and lower prothrombin time (PT), activated partial thromboplastin time, D-dimer levels, thrombin time, lower the visual analog scale/score, and circumference diameter of knee joint were observed in the 10 and 15 mg/kg TA groups compared with the control group at 7 and 14 days after surgery. At 1 and 3 months after surgery, the knee joint range of motion scores, Hospital for Special Surgery scores, and Knee Society Score were increased in 10 and 15 mg/kg TA groups in comparison to the control group. TA could reduce occult blood loss and blood transfusion rate and improve recovery of knee function in patients undergoing TKA.

Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice

BackgroundDespite being widely recognized as the most common form of secondary hypertension, among the general hypertensive population the true prevalence of primary aldosteronism (PA) and its main subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH), remains a matter of debate. ObjectivesThis study sought to determine the prevalence and clinical phenotype of PA in a large cohort of unselected patients with hypertension, consecutively referred to our hypertension unit, by 19 general practitioners from Torino, Italy. MethodsFollowing withdrawal from all interfering medications, patients were screened for PA using the ratio of serum aldosterone to plasma renin activity. PA was diagnosed according to Endocrine Society guidelines. The diagnosis was confirmed or excluded by an intravenous saline infusion test or captopril challenge test and subtype differentiation was performed by adrenal computed tomography scanning and adrenal vein sampling, using strict criteria to define successful cannulation and lateralization of aldosterone production. ResultsA total of 1,672 primary care patients with hypertension (569 newly diagnosed and 1,103 patients already diagnosed with arterial hypertension) were included in the study. A total of 99 patients (5.9%) were diagnosed with PA and conclusive subtype differentiation by adrenal vein sampling was made in 91 patients (27 patients with an APA and 64 patients with BAH). The overall prevalence of PA increased with the severity of hypertension, from 3.9% in stage 1 hypertension to 11.8% in stage 3 hypertension. Patients with PA more frequently displayed target organ damage and cardiovascular events compared with those without PA, independent of confounding variables. ConclusionsOur results demonstrated that PA is a frequent cause of secondary hypertension, even in the general population of patients with hypertension, and indicates that most of these patients should be screened for PA.

Does maternal-fetal transfer of creatine occur in pregnant sheep?

Our aim was to determine the disposition of creatine in ovine pregnancy and whether creatine is transferred across the placenta from mother to fetus. Pregnant ewes received either 1) a continuous intravenous infusion of creatine monohydrate or saline from 122 to 131 days gestation, with maternal and fetal arterial blood and amniotic fluid samples collected daily for creatine analysis and fetal tissues collected at necropsy at 133 days for analysis of creatine content, or 2) a single systemic bolus injection of [13C]creatine monohydrate at 130 days of gestation, with maternal and fetal arterial blood, uterine vein blood, and amniotic fluid samples collected before and for 4 h after injection and analyzed for creatine, creatine isotopic enrichment, and guanidinoacetic acid (GAA; precursor of creatine) concentrations. Presence of the creatine transporter-1 (SLC6A8) and l-arginine:glycine amidinotransferase (AGAT; the enzyme synthesizing GAA) proteins were determined by Western blots of placental cotyledons. The 10-day creatine infusion increased maternal plasma creatine concentration three- to fourfold (P < 0.05) without significantly changing fetal arterial, amniotic fluid, fetal tissues, or placental creatine content. Maternal arterial 13C enrichment was increased (P < 0.05) after bolus [13C]creatine injection without change of fetal arterial 13C enrichment. SLC6A8 and AGAT proteins were identified in placental cotyledons, and GAA concentration was significantly higher in uterine vein than maternal artery plasma. Despite the presence of SLC6A8 protein in cotyledons, these results suggest that creatine is not transferred from mother to fetus in near-term sheep and that the ovine utero-placental unit releases GAA into the maternal circulation.

The Black Sea’s poison; Mad Honey

Honey and honey production have been an important source of revenue among the peoples of Anatolia throughout the course of history. Beekeeping is possible everywhere in Turkey thanks to its ecological and geographical features. The best known of these is the type popularly known as ‘mad honey’, the name of which appears in ancient texts, because of its effects on human beings. Its toxic effects are caused by the substance known as grayanotoxin in the flowers of "Rhododendron ponticum", known among the local inhabitants as the forest rose, which grows in high-altitude forested areas in the Black sea region of Turkey. Like other cholinergic toxidromes, treatment with intravenous atropine and normal saline infusion, can be life-saving in this poisoning.

Efficacy of oral supplemental hydration for the prevention of contrast-induced nephropathy in rats.

To compare oral rehydration solution (ORS) with saline infusion for preventing contrast-induced nephropathy (CIN) in a rat model. Adult male Sprague-Dawley rats (310-360g) received intravenous indomethacin (10mg/kg), N G-nitro-L-arginine methyl ester (10mg/kg), and iohexol (10mL/kg) to induce acute contrast-induced renal injury (CIN group); control rats received saline only. For hydration, rats received either continuous infusion (20mL/kg/h) of saline or three oral doses (20mL/kg each) of ORS. Acute renal injury was evaluated by assaying urine collected for 24h beginning 2h before the contrast injection, evaluating blood taken 22h after the contrast injection, and examining the kidneys histopathologically. Hydration with saline prevented only the contrast-induced increase in plasma creatinine, whereas ORS prevented deleterious changes in plasma creatinine, blood urea nitrogen, and creatinine clearance as well as in urinary protein, albumin, and N-acetyl-D-glucosaminidase concentrations. Histopathologic changes noted in the CIN group were diminished in both saline and ORS groups. Both intravenous saline administration and oral hydration with ORS decreased the severity of CIN. Hydration with ORS was comparable to intravenous saline infusion in preventing CIN-associated abnormalities.

Effects of intermittent intravenous saline infusions in patients with medication-refractory postural tachycardia syndrome.

The postural tachycardia syndrome (POTS) is a heterogeneous group of disorders that results in symptoms of orthostatic intolerance. Excess blood pooling has been observed to cause low effective circulating volume in the central vasculature. Consequently, acute volume loading with IV saline has emerged as a potential strategy for clinical intervention. We evaluated the impact of acute volume loading on both the signs and symptoms of patients suffering from POTS. Fifty-seven subjects screened from our population of POTS patients and assenting to participation were administered the two surveys by telephone. Subjects completed each survey twice, before, and after initiating IV hydration therapy. The Orthostatic Hypotension Questionnaire (OHQ) was used to assess change in clinical symptomatology, while the short form 36 health survey (SF-36) was employed to assess the impact of IV saline infusion on quality of life. Fifty-seven patients were included in the analysis. The average number of medications trialed before referral for IV hydration was 3.6 ± 1.7 medications. Saline infusions occurred with mean frequency of 11.3 ± 8.5days and at a mean volume of 1.5 ± 0.6l per infusion. The mean change of the OHQ was 3.1 ± 0.3 (95% CI 2.6-3.7; P < 0.001), with significant improvement in all the composite scores. The mean change in the SF-36 form was 19.1 ± 2.7 (95% CI -24.6 to -13.6; P < 0.001). Intermittent IV infusions of saline dramatically reduce symptoms and improve quality of life in patients suffering from POTS. Further work should explore its efficacy as a bridge study for patients of high symptomatic severity.