Low Osmolality Research Articles

6768 A Rare Presentation of Primary Adrenal Insufficiency with Hypertension & Hypokalemia

Abstract Disclosure: A.M. San Hernandez: None. R. Alshantti: None. G. Espinoza Mercado: None. J.L. San Hernandez: None. Introduction: Adrenal Insufficiency is caused by the failure of the adrenal cortex to produce glucocorticoids +/- mineralocorticoids. This can be due to a defect in the adrenal cortex, or in the hypothalamic pituitary axis. The clinical manifestations are usually non-specific, ranging from mild vague symptoms to life threatening crisis. Therefore, diagnosis requires a high level of suspicion by providers. Unusual presentations of primary adrenal insufficiency (PAI) with hypertension and hypokalemia have been rarely described in the literature. We present a rare case of PAI with hypertension and hypokalemia. Case Presentation: A 68 years old female with a medical history of rheumatoid arthritis, hypothyroidism on Levothyroxine, chronic transaminitis, and bicytopenia presented to the hospital with a 6 weeks history of generalized weakness, loss of appetite, weight loss, and dizziness. Patient denied any diuretic or steroid use within the last 2 years. On arrival, she was afebrile, hypertensive (168/84mmHg), with normal oxygenation and pulse. Physical examination was unremarkable with normal volume status. Initial laboratory results showed low sodium 116 mEq/L, low serum osmolality 247 MEQ/kg, normal potassium 3.6 mEq/L, Creatinine 0.3 mg/dL & BUN 9 mg/dL. She was initially started on IVF normal saline. Further workup revealed normal TSH & FT4 levels. Urine study showed urine osmolality (477 MOSM/KG), & urine sodium (127 mEq/L). Given these findings, SIADH was suspected and fluid restriction was started. Sodium level continued to be low with minimal improvement to 120 mEq/L, potassium levels also dropped (3.3-3.2 mEq/L), requiring daily replacement. BP remained elevated ranging from 150s to 160s systolic and 80s to 90s diastolic. Hypertension was controlled with her home medication Amlodipine. Although atypical presentation with hypertension & hypokalemia, the diagnosis of adrenal insufficiency was considered. Laboratory evaluation showed low morning cortisol 5.2 ug/dL, with album level 3.5 g/dL. Cosyntropin stimulation test showed 1.3 ug/dL (at baseline), 9.9 (30 min post administration), and 14.4 (1 hour post administration); results confirming PAI. ACTH, Renin, Aldosterone, & DHEAS levels were normal. CT adrenal was normal. Patient was started on hydrocortisone; some of her symptoms & Na level improved. Further investigation of the etiology of PAI and possible hyperaldosteronism is pending outpatient follow up. Conclusion: Adrenal insufficiency is a life threatening condition with serious consequences if diagnosis is missed. It manifests by a wide spectrum of symptoms and signs, some can be masked by the presence of other comorbid conditions leading to atypical presentations. Our case highlights the importance of maintaining a high level of suspicion of adrenal insufficiency in patients with atypical presentation, including those with hypertension & hypokalemia. Presentation: 6/3/2024

Effect of Human Milk Fortifiers, Medium-chain Triglyceride Oil, Minerals, and Vitamin Supplements on the Osmolality of Pasteurized Donor Human Milk

Aim: We aimed to study the changes in osmolality of pasteurized donor human milk (PDHM) after the addition of four human milk fortifiers (HMFs), medium-chain triglyceride (MCT) oil, minerals, and vitamin supplements commonly used in neonates. Methods: The osmolality of 25 ml of PDHM was measured after the addition of 1 g each of HMF and 0.5 ml of MCT oil separately with a calibrated osmometer. The osmolality of 5 ml of PDHM was measured after the addition of minerals and vitamin supplements in therapeutic doses separately. All these measurements were carried out at 10 min, 30 min, and 2 h by a technician who was blinded to the fortifiers, minerals, and vitamin supplements used. Results: The osmolality of PDHM was 256 mOsm/kg (range = 256–259 mOsm/kg), which increased with all four HMFs tested, but remained below 450 mOsm/kg as recommended by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). Proprietary fortifiers increased the osmolality of PDHM to a maximum of 429 mOsm/kg (range = 306–429 mOsm/kg). However, there was no change in the osmolality with MCT oil. A maximum increase in osmolality was observed with the addition of calcium phosphate syrup to PDHM (1181 mOsm/kg). The addition of multivitamins and Vitamin D3 in therapeutic doses increased osmolality (range = 552–753 mOsm/kg) beyond the safety limits of ESPGHAN recommendation. Conclusions: HMFs increased the osmolality of PDHM but were within the safety limits of ESPGHAN recommendation. MCT oil did not affect the osmolality of PDHM. Minerals and vitamin supplements added in therapeutic dosages significantly increased the osmolality of PDHM. Minerals and vitamin supplements need to be appropriately diluted to keep osmolality below 450 mOsm/kg to ensure safety. Future research should focus on manufacturing fortifiers and supplements with low osmolality to ensure safety.

Association between serum osmolality and deteriorating renal function in patients with acute myocardial infarction: analysis of the MIMIC- IV database

BackgroundTo investigate the association between serum osmolality and deteriorating renal function in patients with acute myocardial infarction (AMI).MethodsThree thousand eight hundred eighty-five AMI patients from the Medical Information Mart for Intensive Care IV were enrolled for this study. The primary outcome was deteriorating renal function. Secondary outcomes included the new-onset of acute kidney injury (AKI) and progress of AKI. < 293.2725 mmol/L was defined as low serum osmolality, and ≥ 293.2725 mmol/L as high serum osmolality based on upper quartile. Univariate and multivariate logistic regression models were used to explore the associations between serum osmolality and the development of deteriorating renal function, the new-onset of AKI and progress of AKI among AMI patients. Subgroup analysis was also conducted.ResultsOne thousand three hundred ninety-three AMI patients developed deteriorating renal function. After adjusting all confounding factors, high serum osmolality was associated with increased risk of deteriorating renal function [odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.22–1.78], new-onset of AKI (OR = 1.31, 95% CI: 1.01–1.69), and progress of AKI risk (OR = 1.26, 95% CI: 1.01–1.59) among AMI patients. In addition, when the stratified analysis was performed for age, AMI type, cardiogenic shock, and estimated glomerular filtration rate (eGFR), high serum osmolality was risk factor for the risk of deteriorating renal function among patients aged 65 years or older, without cardiogenic shock, and with an eGFR ≥ 60 mL/min/1.73m2.ConclusionHigher serum osmolality increased the risk of deteriorating renal function among AMI patients.

OpgH is an essential regulator of Caulobacter morphology.

Bacterial growth and division rely on intricate regulation of morphogenetic complexes to remodel the cell envelope without compromising envelope integrity. Significant progress has been made in recent years towards understanding the regulation of cell wall metabolic enzymes. However, other cell envelope components play a role in morphogenesis as well. A primary factor required to protect envelope integrity in low osmolarity environments is OpgH, the synthase of osmoregulated periplasmic glucans (OPGs). Here, we demonstrate that OpgH is essential in the α-proteobacterium Caulobacter crescentus. Unexpectedly, depletion of OpgH or attempted complementation with a catalytically dead OpgH variant results in striking asymmetric bulging and cell lysis. These shape defects are accompanied by reduced cell wall synthesis and mislocalization of morphogenetic complexes. Interestingly, overactivation of the CenKR two-component system that has been implicated in cell envelope stress homeostasis in α-proteobacteria phenocopies the morphogenetic defects associated with OpgH depletion. Each of these perturbations leads to an increase in the levels of the elongasome protein, MreB, and decreases in the levels of divisome proteins FtsZ and MipZ as well as OpgH, itself. Constitutive production of OpgH during CenKR overactivation prevents cell bulging, but cells still exhibit morphogenetic defects. We propose that OPG depletion activates CenKR, leading to changes in the expression of cell envelope-related genes, but that OPGs also exert CenKR-independent effects on morphogenesis. Our data establish a surprising function for an OpgH homolog in morphogenesis and reveal an essential role of OpgH in maintaining cell morphology in Caulobacter.IMPORTANCEBacteria must synthesize and fortify the cell envelope in a tightly regulated manner to orchestrate growth and adaptation. Osmoregulated periplasmic glucans (OPGs) are important, but poorly understood, constituents of Gram-negative cell envelopes that contribute to envelope integrity and protect against osmotic stress. Here, we determined that the OPG synthase OpgH plays a surprising, essential role in morphogenesis in Caulobacter crescentus. Loss of OpgH causes asymmetric cell bulging and lysis via misregulation of the localization and activity of morphogenetic complexes. Overactivation of the CenKR two-component system involved in envelope homeostasis phenocopies OpgH depletion, suggesting that depletion of OpgH activates CenKR. Because cell envelope integrity is critical for bacterial survival, understanding how OpgH activity contributes to morphogenesis and maintenance of envelope integrity could aid in the development of antibiotic therapies.

Vascular Calcification Is Accelerated by Hyponatremia and Low Osmolality.

Hyponatremia, frequently observed in patients with chronic kidney disease, is associated with increased cardiovascular morbidity and mortality. Hyponatremia or low osmolality induces oxidative stress and cell death, both of which accelerate vascular calcification (VC), a critical phenotype in patients with chronic kidney disease. Whether hyponatremia or low osmolality plays a role in the pathogenesis of VC is unknown. Human vascular smooth muscle cells (VSMCs) and mouse aortic rings were cultured in various osmotic conditions and calcifying medium supplemented with high calcium and phosphate. The effects of low osmolality on phenotypic change and oxidative stress in the cultured VSMCs were examined. Microarray analysis was conducted to determine the main signaling pathway of osmolality-related VC. The transcellular sodium and calcium ions flux across the VSMCs were visualized by live imaging. Furthermore, the effect of osmolality on calciprotein particles (CPPs) was investigated. Associations between arterial intimal calcification and hyponatremia or low osmolality were examined by a cross-sectional study using human autopsy specimens obtained in the Hisayama Study. Low osmolality exacerbated calcification of the ECM (extracellular matrix) of cultured VSMCs and mouse aortic rings. Oxidative stress and osteogenic differentiation of VSMCs were identified as the underlying mechanisms responsible for low osmolality-induced VC. Microarray analysis showed that low osmolality activated the Rac1 (Ras-related C3 botulinum toxin substrate 1)-Akt (protein kinase B) pathway and reduced NCX1 (Na-Ca exchanger 1) expression. Live imaging showed synchronic calcium ion efflux and sodium ion influx via NCX1 when extracellular sodium ion concentrations were increased. An NCX1 inhibitor promoted calcifying media-induced VC by reducing calcium ion efflux. Furthermore, low osmolality accelerated the generation and maturation steps of CPPs. The cross-sectional study of human autopsy specimens showed that hyponatremia and low osmolality were associated with a greater area of arterial intimal calcification. Hyponatremia and low osmolality promote VC through multiple cellular processes, including the Rac1-Akt pathway activation.

Integrated sperm movement, proteomics, and phosphoproteomics elucidate the roles of osmolality, ions, and key proteins in sperm activation of Nile tilapia (Oreochromis niloticus)

Nile tilapia (Oreochromis niloticus) is an important aquaculture fish around the world and has a wide range of tolerance to salinity, providing great economic value in aquaculture industry and showing an excellent ecological adaptation. However, the best sperm activation condition and sperm activation mechanism of this euryhaline fish remains unclear. In this study, we applied the sperm movement analysis, proteomics, and phosphoproteomics to explore the effects of osmolality and ions and to reveal sperm activation mechanism of Nile tilapia. Our results showed that low osmolality contributed to sperm activation compared with high osmolality. Adding Na+ and Ca2+ enhanced sperm motility after sperm activation. Under 100 mOsm·kg−1, adding 44 mM Na+ and 4 mM Ca2+ was a successful protocol for sperm activation. Proteomics and phosphoproteomics analyses identified 677 differentially expressed proteins and 245 differentially expressed phosphorylated proteins, respectively, among which 21 proteins and 11 phosphorylated proteins as key molecules were involved in Ca2+ mediated signal transduction, glucose metabolism, lipid metabolism, and apoptotic cell death. Key protein ORAI1 promoted extracellular Ca2+ influx to activate Ca2+ mediated signal transduction. Converting glycogenolysis and glycolysis to pyruvate metabolism and fatty acid β-oxidation was a critical energy metabolic adaptation mechanism. The Hsp90 was a critical sperm activation biomarker in loosing of sperm motility and apoptosis. A putative proteomic and phosphoproteomic response network was constructed to reveal the sperm activation mechanism of Nile tilapia. Our study provides a new insight into sperm activation mechanism of this euryhaline fish and facilitates future application of best activation protocol to the fertilization and breeding of Nile tilapia.

Heart failure related fatigue: An exploratory analysis of serum osmolality from the national health and nutrition examination survey

BackgroundFatigue is a prominent symptom of heart failure (HF). However, underlying mechanisms remain poorly understood. Fluid volume status has been suggested as a physiologic mechanism of HF-related fatigue. Serum osmolality may fluctuate with changes in volume status associated with neurohormonal dysregulation. The relationship of fatigue to serum osmolality has not been assessed in adults with HF. ObjectivesDescribe the relationship between serum osmolality and fatigue in adults with HF. MethodsWe analyzed two waves of cross-sectional data from the National Health and Nutrition Examination Survey (2015–2016 and 2017–2018). Adults who self-reported having HF without select co-morbid conditions known to contribute to fatigue were included. Data were weighted to provide US national estimates, and complex sample design used for analyses. Sequential logistic regression was used to isolate the effect of serum osmolality on the odds of having fatigue. ResultsData from the sample represented 1.4 million Americans with HF (58.5 % male; median age 68 years), of whom 1,001,589 (67.9 %) reported fatigue. Participants with fatigue had lower serum osmolality compared to those without fatigue (t = -3.04, p = .009). Higher serum osmolality was associated with 8.8 % lower odds of experiencing fatigue when controlling for sex and body mass index (OR = 0.912, p = .007, CI 0.857 - 0.972). ConclusionsHF-related fatigue is associated with lower serum osmolality. Low serum osmolality may indicate excess volume and the presence of a heightened neurohormonal response, both of which may influence fatigue. Alternatively, serum osmolality may directly affect other physiologic changes that may contribute to fatigue.

Acute Diarrhoea in Children Aged Up to 2 Years Age Group: Assessment of Therapeutic Strategies and Hospital Stay Variance, in Tertiary Care Rural Hospital – An Observational Study

Acute Diarrhoea, it is one of the leading causes of under 5 childrens’ morbidity and mortality in India. It is most common in children especially those between 6 months and 2 years. Antimicrobials are mostly used drug for acute diarrhoeal cases according to many studies but according to WHO antibiotics are not required for all the diarrhoeal cases except few bacterial diarrhoeas. Other way, WHO recommends Zinc with low osmolarity ORS for acute diarrhoea. So, this study was designed for assessing the treatment pattern and its outcome in our setup. Objectives: - To assess the use of antibiotics and Zinc among children under 2 years suffering from acute Diarrhoea by analysing average of use and hospital stay. Materials and Methods: - This observational study includes 76 patients, admitted under Paediatric Department of Mahatma Gandhi Institute of Medical Sciences, in the period of 6 months. All the patients admitted during the study period having acute Diarrhoea with moderate dehydration as per definition of WHO was included in the study. Patients with other existing diseases, bloody diarrhoea and seriously ill were excluded. Data was collected from Paediatric ward and was analysed by using GraphPad software. Results: - Over all among the 76 patients, 25(32.89%) patients received antimicrobials only and 31(40.79%) received Zinc only and11(14.47%) patients received both. Hospital stay difference was not statistically significant in culture negative acute diarrhoea cases with the use of zinc and antimicrobials (p = 0.08) but it was significant in culture positive cases (p = 0.03). Conclusion: - In culture negative acute diarrhoeal cases Zinc was mostly used and hospital stay was not found to be significant with and without antimicrobials. Implication: - Uncomplicated acute diarrhoeal cases may be treated with Zinc alone effectively.

Relationships among Hydrogen Peroxide Concentration, Catalase, Glucose Oxidase, and Antimicrobial Activities of Honeys.

Honey is a natural sweetener made by bees that exhibits antimicrobial activity, mainly related to its H2O2 content. The aim of this work was to research the H2O2 concentration of 24 Spanish honeys from different botanical origins, studying their possible correlation with glucose oxidase (GOx), catalase (CAT), and anti-Staphylococcus aureus activities (minimal inhibition concentration (MIC), minimal bactericidal concentration (MBC), and percentage of inhibition at 5% (w/v) honey against Staphylococcus aureus), as well as possible correlations among all the analyzed parameters. The results showed that the H2O2 concentration did not depend on the botanical origin of the honeys. There were neither correlations between the H2O2 concentration and the activities of GOx and CAT, nor between GOx and antimicrobial activity. However, CAT and antimicrobial activities were positively correlated. Therefore, CAT could be successfully used as a possible marker of the antimicrobial activity of honeys against Staphylococcus aureus. Furthermore, a linear regression model has been fitted to explain the antimicrobial activity from CAT and GOx activity and H2O2 concentration. Although H2O2 is one of the compounds involved in honey's antibacterial activity, this capacity also strongly depends on other honey components (such as low water activity, acidity, osmolarity, and phenolic compounds). The very high anti-Staphylococcus aureus activity exhibited by all samples could be interesting for commercial honey-based formulations also helping to promote local beekeeping.

Congenital nephrogenic diabetes insipidus with a novel variant of AVPR2 gene mutation: A case report

ABSTRACT Congenital nephrogenic diabetes insipidus (CNDI) is a rare genetic disorder characterized by impaired water reabsorption despite normal or elevated levels of antidiuretic hormone. We report a 6-month-old male with classical symptoms of CNDI, such as fever, excessive thirst, polyuria, and failure to thrive. Laboratory investigations revealed hypernatremia, low urine osmolality, and a lack of response to a vasopressin challenge, confirming the diagnosis. Genetic testing identified a hemizygous base pair deletion in the AVPR2 gene, leading to a frameshift mutation and premature protein truncation. Treatment strategies, including hydrochlorothiazide and amiloride therapy, aim to manage symptoms and improve quality of life. Long-term management involves monitoring growth, hydration status, and genetic counseling for affected families. This case highlights the importance of early recognition and management of CNDI to prevent long-term sequelae. Further research into genetic variations and novel therapeutic approaches is warranted to improve outcomes for these children.

Machine learning-based prediction of tear osmolarity for contact lens practice.

This study addressed the utilisation of machine learning techniques to estimate tear osmolarity, a clinically significant yet challenging parameter to measure accurately. Elevated tear osmolarity has been observed in contact lens wearers and is associated with contact lens-induced dry eye, a common cause of discomfort leading to discontinuation of lens wear. The study explored machine learning, regression and classification techniques to predict tear osmolarity using routine clinical parameters. The data set consisted of 175 participants, primarily healthy subjects eligible for soft contact lens wear. Various clinical assessments were performed, including symptom assessment with the Ocular Surface Disease Index and 5-Item Dry Eye Questionnaire (DEQ-5), tear meniscus height (TMH), tear osmolarity, non-invasive keratometric tear film break-up time (NIKBUT), ocular redness, corneal and conjunctival fluorescein staining and Meibomian glands loss. The results revealed that simple linear regression was insufficient for accurate osmolarity prediction. Instead, more advanced regression models achieved a moderate level of predictive power, explaining approximately 32% of the osmolarity variability. Notably, key predictors for osmolarity included NIKBUT, TMH, ocular redness, Meibomian gland coverage and the DEQ-5 questionnaire. In classification tasks, distinguishing between low (<299 mOsmol/L), medium (300-307 mOsmol/L) and high osmolarity (>308 mOsmol/L) levels yielded an accuracy of approximately 80%. Key parameters for classification were similar to those in regression models, emphasising the importance of NIKBUT, TMH, ocular redness, Meibomian glands coverage and the DEQ-5 questionnaire. This study highlights the potential benefits of integrating machine learning into contact lens research and practice. It suggests the clinical utility of assessing Meibomian glands and NIKBUT in contact lens fitting and follow-up visits. Machine learning models can optimise contact lens prescriptions and aid in early detection of conditions like dry eye, ultimately enhancing ocular health and the contact lens wearing experience.

Low daily water intake profile-is it a contributor to disease?

Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.

Comparing novel sperm extenders for the internally-fertilizing tiger salamander (Ambystoma tigrinum)

Due to the concentrated nature and small volume of spermic milt that is typically produced from internally-fertilizing salamanders, an extender is needed to analyze the sperm for quality and quantity metrics. Techniques for diluting salamander sperm for analysis have thus far utilized low osmolality media, which are likely physiologically distinct from the salamander female reproductive tract. Application of mammalian sperm extenders could maintain salamander sperm motility and morphology in storage longer due to the similar nature of internal fertilization in both taxa. Several sperm extenders were tested including: Multipurpose Handling Medium, Sperm Washing Medium, Modified Ham’s F-10 Basal Medium (HAM’s), Refrigeration Medium, and 10% Holtfreter’s solution as a control. The experimental treatments were divided into two groups: diluted (90 mOsm, the approximate osmolality of salamander sperm) and undiluted (280-320 mOsm). Milt samples were collected from male tiger salamanders (N=11) and diluted 1:50 with each of the treatments and measured for sperm progressive motility, total motility, and normal morphology every 10 minutes for one hour. When comparing the diluted versus undiluted treatments of the same extender, there was no difference (p&amp;gt;0.05) for any of the response variables. In addition, we found that 10% Holtfreter’s solution is best for maintaining progressive motility, while diluted HAM’s is best for retaining total motility and normal morphology over time. Overall, we found that osmolality is not a key driver influencing tiger salamander sperm motility, but rather other factors such as ionic composition or pH could be affecting sperm form and function.

A case of central diabetes insipidus after COVID-19 as a probable diagnosis of lymphocytic infundibulo-neurohypophysitis with positive anti-rabphilin-3A antibodies with review of literature.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, and various complications have been reported. Furthermore, there have been increasing reports of endocrinopathy related to COVID-19 following the pandemic. We report a 49-year-old healthy woman who developed rapid onset of polydipsia and polyuria three weeks after COVID-19. Laboratory tests indicated low urine osmolarity and increased serum osmolarity, and antidiuretic hormone (ADH) was undetectable. Urine osmolality remained low with water deprivation. Similarly, plasma ADH responses to hypertonic-saline infusion were blunted and urine osmolality increased in response to desmopressin. There was no clear evidence of anterior pituitary dysfunction. T1-weighted magnetic resonance imaging (MRI) showed pituitary stalk thickening and absence of posterior pituitary bright signal spots, suggesting the presence of hypophysitis. Based on these results, we made a probable diagnosis of lymphocytic infundibulo-neurohypophysitis (LINH) which have caused central diabetes insipidus. Positive findings for serum anti-rabphilin-3A antibodies, reported as a potential diagnostic marker for LINH, were also noted. Following oral desmopressin administration, polydipsia and polyuria were quickly improved, though treatment with desmopressin was still required over four months. This is the first report of a patient with a probable diagnosis of LINH after COVID-19 who tested positive for anti-rabphilin-3A antibodies. Positive findings for those antibodies suggest that pituitary dysfunction associated with COVID-19 is hypophysitis involving an abnormal immune mechanism. The presence of anti-rabphilin-3A antibodies may be useful as a non-invasive diagnostic marker of LINH and potentially serve as a valuable diagnostic aid in cases of LINH associated with COVID-19.

Acute gastroenteritis-changes to the recommended original oral rehydrating salts: a review.

The World Health Organization recommended a formulation of oral rehydration salts as the intervention of choice for the treatment of acute gastroenteritis. While of value for the replacement of fluids and electrolytes, the formulation does not reduce stool volume, frequency, or symptom duration. This may prevent wide acceptance. To increase tolerability, shorten the duration of diarrhea and improve parental quality of life, several modifications to the original formula have been proposed. These include; low osmolarity, rice-based, glucose polymers as an alternative to glucose, the addition of probiotics, prebiotics and/or zinc, and various other ingredients. Here we summarize evidence regarding such changes and additions.

Liposome-camouflaged iodinated mesoporous silica nanoparticles with high loading capacity, high hemodynamic stability, high biocompatibility and high radiopacity

Due to their low osmolality and high tolerability, the highly water-soluble nonionic iodinated contrast agents, such as Ioversol (IV), are widely used as clinical agents for CT imaging. However, their clinical applications still are severely limited by the rapid renal excretion, serious adverse effects especially contrast-induced nephropathy and inefficient targetability. Various nanocarriers have demonstrated tremendous potential for achieving high imaging efficiency and low side effects. However, few nanoparticulate contrast agents can simultaneously integrate the desirable functions for imaging, including high loading capacity of iodine, high structure stability for systemic circulation, high biocompatibility and high radiopacity. Herein, we designed and prepared a kind of new radiopaque liposome-camouflaged iodinated mesoporous silica nanoparticles (OIV-MSNs@Liposomes) as contrast agents in CT imaging. Their composition, structure, morphology, biocompatibility and physicochemical properties as well as in vitro radiopacity were investigated in detail. The results indicated that OIV-MSNs@Liposomes can integrate their individual advantages of liposomes and MSNs, thus exhibiting great potential for use in the CT imaging. Considering the simple preparation process and readily available starting materials as well as enhanced biosafety and high performance in X-ray attenuation, the strategy reported here offers a versatile route to efficiently deliver highly water-soluble nonionic iodinated contrast agents for enhanced CT imaging, which are unattainable by traditional means.

Serum osmolality was non-linearly associated with the risk of all-cause and cardiovascular mortality in patients with diabetes

AimsThis study aimed to evaluate the relationship between both low and high osmolarity and the risk of all-cause and cause-specific mortality in diabetic population.MethodsAll participants were included from the National...

Temperature modulates the osmosensitivity of tilapia prolactin cells

In euryhaline fish, prolactin (Prl) plays an essential role in freshwater (FW) acclimation. In the euryhaline and eurythermal Mozambique tilapia, Oreochromis mossambicus, Prl cells are model osmoreceptors, recently described to be thermosensitive. To investigate the effects of temperature on osmoreception, we incubated Prl cells of tilapia acclimated to either FW or seawater (SW) in different combinations of temperatures (20, 26 and 32 °C) and osmolalities (280, 330 and 420 mOsm/kg) for 6 h. Release of both Prl isoforms, Prl188 and Prl177, increased in hyposmotic media and were further augmented with a rise in temperature. Hyposmotically-induced release of Prl188, but not Prl177, was suppressed at 20 °C. In SW fish, mRNA expression of prl188 increased with rising temperatures at lower osmolalities, while and prl177 decreased at 32 °C and higher osmolalities. In Prl cells of SW-acclimated tilapia incubated in hyperosmotic media, the expressions of Prl receptors, prlr1 and prlr2, and the stretch-activated Ca2+ channel, trpv4,decreased at 32 °C, suggesting the presence of a cellular mechanism to compensate for elevated Prl release. Transcription factors, pou1f1, pou2f1b, creb3l1, cebpb, stat3, stat1a and nfat1c, known to regulate prl188 and prl177, were also downregulated at 32 °C. Our findings provide evidence that osmoreception is modulated by temperature, and that both thermal and osmotic responses vary with acclimation salinity.

The diagnosis and management of dehydration in children with wasting or nutritional edema: A systematic review.

Dehydration is a major cause of death among children with wasting and diarrhea. We reviewed the evidence for the identification and management of dehydration among these children. Two systematic reviews were conducted to assess 1) the diagnostic performance of clinical signs or algorithms intended to measure dehydration, and 2) the efficacy and safety of low-osmolarity ORS versus ReSoMal on mortality, treatment failure, time to full rehydration, and electrolyte disturbances (management review). We searched PubMed/Medline, Embase, and Global Index Medicus for studies enrolling children 0-60 months old with wasting and diarrhea. The diagnostic review included four studies. Two studies found the Integrated Management of Childhood Illness (IMCI) and the Dehydration: Assessing Kids Accurately (DHAKA) algorithms had similar diagnostic performance, but both algorithms had high false positive rates for moderate (41% and 35%, respectively) and severe (76% and 82%, respectively) dehydration. One further IMCI algorithm study found a 23% false positive rate for moderate dehydration. The management review included six trials. One trial directly compared low osmolarity ORS to ReSoMal and found no difference in treatment failure rates, although ReSoMal had a shorter duration of treatment (16.1 vs. 19.6 hours, p = 0.036) and a higher incidence of hyponatremia. Both fluids failed to correct a substantial number of hypokalemia cases across studies. In conclusion, the IMCI dehydration assessment has comparable performance to other algorithms among wasted children. Low osmolarity ORS may be an alternative to ReSoMal for children with severe wasting, but might require additional potassium to combat hypokalemia.

The Content of Bioactive Compounds and Technological Properties of Matcha Green Tea and Its Application in the Design of Functional Beverages.

Matcha is a powdered green tea obtained from the Camellia sinensis L. plant intended for both "hot" and "cold" consumption. It is a rich source of bioactive ingredients, thanks to which it has strong antioxidant properties. In this research, an organoleptic evaluation was carried out, and the physical characteristics (i.e., instrumental color measurement (L*a*b*), water activity, water solubility index (WSI), water holding capacity (WHC) of 10 powdered Matcha green teas, and in the 2.5% Matcha water solutions, pH, °Brix and osmolality were tested. Also, the content of phenolic ingredients, i.e., selected phenolic acids, flavonoids and total polyphenols, was assessed. The content of chlorophyll, vitamin C and antioxidant potential were also examined. Matcha M-4 was used to design two functional model beverages, in the form of ready-to-use powdered drinks, consisting of Matcha green tea, protein preparations, inulin, maltodextrin and sugar. The obtained powdered drink, when dissolved in the preferred liquid (water, milk, juice), is regenerative, high-protein and rich in bioactive ingredients from the Matcha drink, with prebiotic properties derived from the added inulin. The beverage is also characterized by low osmolality. It can be recommended as a regenerating beverage for a wide group of consumers, athletes and people with deficiencies, among others protein, and elderly people, as well as in the prevention and supportive treatment of bone and joint tissue diseases.