Hyponatremia Research Articles

Quality assessment using water quality indicators with geospatial analysis of groundwater quality El-Oued region, Northern Sahara, Algeria

ABSTRACT The present study was carried out to assess groundwater quality in two layers (Albian and complex terminal) intended for irrigation, to identify their original chemical composition and overall risk by different attack techniques in the province of El-Oued. Eleven physico-chemical parameters were measured at 16 locations. Emphasis was placed on the selection of irrigation water quality index (IWQI) inputs through the application of multivariate statistical analysis, the estimation of various classical irrigation indices, and the integration of geographic information systems. The results of the IWQI, sodium adsorption ratio, Kelly index, permeability index, residual sodium carbonate and magnesium hazard showed that the majority of groundwater samples were classified for irrigation purposes in the following categories: severely restricted (100%), low sodium and excellent (100%), good (93.75%), marginally safe (100%), good (100%) and suitable (81.25%), respectively. In addition, the majority of selected samples were classified as “good to eligible for irrigation” based on %Na as shown in the distribution map. Whereas the principal component analysis results show that the four factors together explain 72.74% of the total variance according to the Kaiser rule. Cluster analysis divides the parameters into three groups. In summary, the combination of the geographic system and irrigation quality indices is useful for identifying irrigation zones.

The Diagnosis of Hyponatremia Results from the Determination of Serum Electrolytes

Hyponatremia is an electrolyte disorder characterized by low sodium concentrations in human blood. The appearance of hyponatremia can be associated with a decrease, increase, or normal amount of extracellular fl uid, depending on the disorder or pathological condition. The symptoms of hyponatremia are most often caused by a decrease in plasma osmolarity, which causes water to enter the cells, resulting in cellular edema. Keywords: Hyponatremia, Symptoms, Patients, Diagnosis, Health.

Continuous Flow Electrochemical Synthesis of Olivine-Structured NaFePO4 Cathode Material for Sodium-Ion Batteries from Recycle LiFePO4.

To mitigate the environmental impact of the improper disposal of spent LiFePO4 batteries and reduce resource waste, the development of LiFePO4 recycling technologies is of paramount importance. Meanwhile, olivine-structured NaFePO4 in sodium-ion batteries has received great attention, due to its high theoretical specific capacity of 154 mAh g-1 and excellent stability. However, olivine NaFePO4 only can be synthesized from olivine LiFePO4. Accordingly, in this proposal, developing the continuous flow electrochemical solid-liquid reactor-based metal ion insertion technology is to utilize the olivine FePO4, recycled from LiFePO4, and to synthesize NaFePO4. Additionally, by employing I- as the reducing agent, NaFePO4 is successfully synthesized with a discharge-specific capacity of 134 mAh g-1 at 0.1C and a remarkable capacity retention rate of 86.5% after 100 cycles at 0.2C. And the reasons for sodium deficiency in the synthesized NFP are elucidated through first-principles calculations. Furthermore, the kinetics of the solid-solution reaction 2 (Na2/3+βPO4→ Na1-αFePO4) mechanism improve with cycling and are sensitive to temperature. Utilizing a minimal amount of reducing agent in the electrochemical reactor, NaFePO4 synthesis is successfully achieved. This innovative approach offers a new, cost-effective, and environmentally friendly strategy for preparing NaFePO4 from recycling LiFePO4.

Manipulating Pb Vacancies Achieved Ultra‐High Thermoelectrics in Quaternary Pb0.95Na0.04Te1‐xSex via Fine‐Tuning Se Solubility

AbstractOptimizing carrier concentration in PbTe materials can be achieved effectively through the chemical doping of sodium. Nevertheless, the valence balance can lead to the presence of “deleterious defects” in the PbTe matrix, resulting in low sodium solubility at room temperature. Herein, a strategy for fine‐tuning Pb vacancies to improve sodium solubility is developed. By a trace amount of Se‐doping, the solubility of Na in Pb0.99Te1‐xSex through the preservation of Pb vacancies in the matrix is substantially increased. Additionally, a large number of dense dislocations in the grains, which greatly reduced the lattice thermal conductivity is induced. A high power factor of ≈26 mW cm−1 K−2 and low lattice thermal conductivity of ≈0.43 W m−1 K−1 at 823 K in Pb0.95Na0.04Te0.97Se0.03 is achieved. Ultimately, a high figure of merit, ZT ≈2.2, is obtained at 823 K in quaternary PbTe compound. The current findings not only demonstrate that the introduction of trace amounts of Se and Pb vacancies in the PbTe matrix can effectively enhance Na solubility and minimize thermal conductivity, attaining synergistic improvement in electrical and thermal properties, but also indicate that the synergistic effect of Pb vacancies with a specific dopant is an alternative approach for enhancing ZT.

Effectiveness and optimization of low-sodium oxybate in participants with narcolepsy switching from a high-sodium oxybate: data from the Substitution of Equal Grams of Uninterrupted Xyrem to Xywav study.

Low-sodium oxybate (LXB; calcium, magnesium, potassium, and sodium oxybates; Xywav) contains the same active moiety as high-sodium oxybates (SXBs; SXB [Xyrem] and fixed-dose SXB [Lumryz]), with 92% less sodium, and is approved in the United States for treatment of cataplexy or excessive daytime sleepiness in patients 7 years of age and older with narcolepsy, and idiopathic hypersomnia in adults. Patients with narcolepsy have increased cardiovascular risk relative to people without narcolepsy. LXB's lower sodium content is recognized by the United States Food and Drug Administration in the narcolepsy population as clinically meaningful in reducing cardiovascular morbidity compared with SXBs. The Substitution of Equal Grams of Uninterrupted Xyrem to Xywav study (NCT04794491) examined the transition experience of patients with narcolepsy switching from SXB to LXB. Eligible participants were aged 18-80 years with narcolepsy type 1 or 2 on a stable SXB dose/regimen. After 2 weeks, participants transitioned gram-per-gram to LXB for 6 weeks, with opportunity for subsequent titration. Assessments included the Epworth Sleepiness Scale, Patient Global Impression of change, Ease of Switching Medication Scale, and Forced Preference Questionnaire. The study enrolled 62 participants at baseline; 60 transitioned to LXB and 54 completed the study. At baseline and end of the LXB intervention/early discontinuation, respectively, mean total doses were 8.0 and 8.0 g/night; mean Epworth Sleepiness Scale scores were 9.4 and 8.8. Most participants reported improvement (45%) or no change (48%) in narcolepsy symptoms on the Patient Global Impression of change, reported the transition to LXB was "easy" (easy, extremely easy, not difficult at all; 93%) on the Ease of Switching Medication Scale, and preferred LXB compared with SXB (79%) on the Forced Preference Questionnaire, most commonly due to the lower sodium content. Most participants switched from SXB to LXB with minimal modifications of dose/regimen and reported the transition process was easy. Effectiveness of oxybate treatment was maintained on LXB, and most participants preferred LXB to SXB. No new safety or tolerability issues were identified. Registry: ClinicalTrials.gov; Name: An Interventional Safety Switch Study (Segue Study) of XYWAV in Narcolepsy; URL: https://classic.clinicaltrials.gov/ct2/show/NCT04794491; Identifier: NCT04794491. Macfadden W, Leary EB, Fuller DS, Kirby MT, Roy A. Effectiveness and optimization of low-sodium oxybate in participants with narcolepsy switching from a high-sodium oxybate: data from the Substitution of Equal Grams of Uninterrupted Xyrem to Xywav study. J Clin Sleep Med. 2024;20(9):1467-1477.

Dysnatremia in a changing climate: A global systematic review of the association between serum sodium and ambient temperature.

Both hyponatremia and hypernatremia have been reported to occur more frequently with higher ambient temperatures, although the underlying mechanisms are not well understood. Global temperatures are rising due to climate change, which may impact the incidence of dysnatremia worldwide. We aimed to identify, collate and critically appraise studies analyzing the relationship between climate measures (outdoor temperature, humidity) and serum sodium concentrations. Systematic review, reported in accordance with PRISMA guidelines. MEDLINE and Embase were searched with relevant key terms. Studies assessing the effect on serum sodium measurement of elevated temperature or humidity versus a comparator were included. Of 1466 potentially relevant studies, 34 met inclusion criteria, originating from 23 countries spanning all inhabited continents. The majority (30 of 34, 88%) reported a significant association between outdoor temperature and dysnatremia, predominantly lower serum sodium with increased ambient temperature. Humidity had a less consistent effect. Individuals aged above 65 years, children, those taking diuretics and antidepressants, those with chronic renal impairment or those undertaking physical exertion had increased vulnerability to heat-associated dysnatremia. The risk of bias was assessed to be high in all but four studies. Higher ambient temperature is consistently associated with an increased incidence of hyponatremia. We infer that hyponatremia presentations are likely to rise with increasing global temperatures and the frequency of extreme heat events secondary to climate change. Evidence-based public health messages, clinician education and reduction in fossil fuel consumption are necessary to reduce the expected burden on healthcare services worldwide.

Changes in serum sodium concentration during hemodialysis is a predictor of mortality and cardio-cerebrovascular event

Background Previous study consistently showed that lower serum sodium (SNa) was associated with a greater risk of mortality in hemodialysis (HD) patients. However, few studies have focused on the change in SNa (ΔSNa = post-HD SNa – pre-HD SNa) during an HD session. Methods In a retrospective cohort of maintenance HD adults, all-cause mortality and cardio-cerebrovascular event (CCVE) were followed up for a medium of 82 months. Baseline pre-HD SNa and ΔSNa were collected; time-averaged pre-HD SNa and ΔSNa were computed as the mean values within 1-year, 2-year and 3-year intervals after enrollment. Cox proportional hazards models were used to evaluate the relationships of pre-HD and ΔSNa with outcomes. Results Time-averaged pre-HD SNa were associated with all-cause mortality (2-year pre-HD SNa: HR [95% CI] 0.86 [0.74–0.99], p = 0.042) and CCVE (3-year pre-HD SNa: HR [95% CI] 0.83 [0.72–0.96], p = 0.012) with full adjustment. Time-averaged ΔSNa also demonstrated an association with all-cause mortality (3-year ΔSNa: HR [95% CI] 1.26 [1.03–1.55], p = 0.026) as well as with CCVE (3-year ΔSNa: HR [95% CI] 1.51 [1.21–1.88], p = <0.001) when fully adjusted. Baseline pre-HD SNa and ΔSNa didn’t exhibit association with both outcomes. Conclusions Lower time-averaged pre-HD SNa and higher time-averaged ΔSNa were associated with a greater risk of all-cause mortality and CCVE in HD patients.

Leaching mechanism of SiO2 in activated kaolinite clinker with low modulus sodium silicate solution

ABSTRACT Preparation of high modulus solution and high Al/Si residue via leaching SiO2 is a key for large amount utilization of coal gangue based on ferric oxide assisted roasting – alkali leaching silica process. This work focuses on leaching mechanism of SiO2 in activated kaolinite clinker with low modulus sodium silicate solution. The results show that the lattice distorted cristobalite produced in the roasting process is readily soluble in sodium silicate solution, however the leaching of SiO2 was only 75% and the modulus of lixiviant reached 2.5 through leaching in sodium silicate solution with a modulus of ~1.0. The leaching kinetics and dissolution mechanism have also been analyzed by model fitting and microstructural observation. The leaching reaction was controlled by diffusion across the pore. The slit – shaped pores formed by the stacking of hercynite particles prevent the diffusion of the bulk solution, thus inhibiting the leaching of cristobalite inside the particles.

Sodium Difluoro(oxalato)borate Additive‐Induced Robust SEI and CEI Layers Enable Dendrite‐Free and Long‐Cycling Sodium‐Ion Batteries

AbstractSodium‐ion batteries (SIBs) are a promising candidate for large‐scale energy storage due to the low cost and abundant sodium resources. However, the formation of sodium dendrites on the surface of hard carbon (HC) anodes is the most intractable challenge for full cells during charging, leading to severe performance degradation and safety hazards. Here, a robust additive‐induced borate and fluoride‐rich interphase is constructed by introducing sodium difluoro(oxalato)borate (NaDFOB) as additive in the ether‐based electrolyte to relieve the performance deterioration for SIBs. NaDFOB can participate in the passivation process of electrolyte‐electrode interfaces through preferential oxidation and reduction of DFOB− to effectively restrain the growth of sodium dendrites. Moreover, the electrolyte decomposition and dissolution of transition metal ions are effectively inhibited. Benefiting from that, FeMn‐based Prussian blue (FeMnHCF) || HC full cell with a negative/positive capacity ratio (N/P ratio) of 1.09 displays a capacity retention of 82.1%, especially with a low N/P ratio of 0.96 the cell still demonstrates a stable Coulombic efficiency of over 99.9% after 500 cycles via using NaDFOB as additive. As a practical demonstration, the designed 18650 full cells display enhanced cycling stability with NaDFOB additive. The findings provide insights into the additive‐induced inorganic‐rich interfacial layers for dendrite‐free SIBs.

Acid-Base Balance in Healthy Adults: Beneficial Effects of Bicarbonate and Sodium-Rich Mineral Water in a Randomized Controlled Trial: The BicarboWater Study.

Noncommunicable diseases (NCDs) are a global health challenge. The complex etiology of NCDs involves genetic, environmental, and lifestyle factors, including dietary habits. Chronic latent metabolic acidosis has been associated with an increased risk of NCDs. Alkalizing diets and mineral water consumption have shown promise in improving acid-base balance and potentially impacting NCDs. In this randomized controlled intervention study, the effect of drinking 1,500-2,000 mL of mineral water daily on acid-base balance was evaluated. Ninety-four healthy participants were divided into two groups: one consumed mineral water with a high bicarbonate and sodium content (HBS, n = 49) and the other consumed mineral water with a low bicarbonate and sodium content (LBS, n = 45). Changes in venous blood gas and urinary acid-base parameters were measured over a short-term (3 days) and long-term (28 days) intervention period. Potential renal acid load (PRAL) and nutrient intake were calculated at baseline and after 28 days. HBS water consumption led to increased urinary pH (24-hour urine and spontaneous urine, both p < 0.001) and bicarbonate levels (p < 0.001), accompanied by reduced titratable acids (p < 0.001) and ammonium (p < 0.001), resulting in a lower renal net acid excretion (p < 0.001). These changes occurred in the short term and persisted until the end of the study. LBS consumption showed no significant effects on urinary pH but led to a slight decrease in bicarbonate (p < 0.001) and NH4 + (p < 0.001), resulting in a slight decrease in NAE (p=0.011). Blood gas changes were modest in both groups. Mineral water consumption in the HBS group altered dietary intake of sodium and chloride, contributing to changes in PRAL values. The study demonstrates that the consumption of mineral water high in bicarbonate and sodium (1,500 mL-2,000 mL/day) can positively influence urinary acid-base parameters and reduce NAE, suggesting potential benefits in maintaining acid-base balance without adverse effects on human health. These findings highlight the importance of mineral water composition in acid-base regulation. This trial is registered with DRKS00025341.

24-Hour Urinary Chemistries and Kidney Stone Risk

Rationale & ObjectiveMost previous studies of the relationship between urinary factors and kidney stone risk have either assumed a linear effect of urinary parameters on kidney stone risk or implemented arbitrary thresholds suggesting biologically implausible “all-or-nothing” effects. In addition, little is known about the hierarchy of effects of urinary factors on kidney stone risk. This study evaluated the independent associations between urine chemistries and kidney stone formation and examined their magnitude and shape. Study DesignProspective cohort study. Setting & ParticipantsWe analyzed 9,045 24-hour urine collections from 6,217 participants of the Health Professionals Follow-Up Study and Nurses’ Health Studies I and II. ExposuresUrine volume and pH, and concentrations of calcium, citrate, oxalate, potassium, magnesium, uric acid, phosphorus, and sodium. OutcomeIncident symptomatic kidney stones. Analytical ApproachMultivariable logistic regression analysis incorporating restricted cubic splines to explore potentially non-linear relationships between urinary factors and the risk of forming a kidney stone. Optimal inflection point analysis was implemented for each factor and dominance analysis was performed to establish the relative importance of each urinary factor. ResultsEach urinary factor was significantly associated with stone formation except for urine pH. Higher urinary levels of calcium, oxalate, phosphorus, and sodium were associated with a higher risk of stone formation, whereas higher urine volume, uric acid, citrate, potassium, and magnesium were associated with a lower risk. The relationships were substantially linear for urine calcium, uric acid, and sodium. In contrast, the magnitudes of the relationships were modestly attenuated at levels above the inflection points for urine oxalate, citrate, volume, phosphorus, potassium, and magnesium. Dominance analysis identified three categories of factors' relative importance: higher (calcium, volume and citrate), intermediate (oxalate, potassium and magnesium) and lower (uric acid, phosphorus and sodium). LimitationsPredominantly white participants, lack of information on stone composition. ConclusionsUrine chemistries have complex relationships and differential relative associations with the risk of kidney stone formation.

Incident Diuretic Use and Subsequent Risk of Bone Fractures: A Large Nationwide Observational Study of US Veterans

ObjectiveTo investigate the association of incident use of diuretics with subsequent risk of incident bone fractures. Patients and MethodsIn a nationwide cohort of 863,339 US veterans receiving care from the VA health care system between October 1, 2004, and September 30, 2006, with follow-up through June 30, 2018, we examined the association of incident diuretic use (overall, and separately by thiazide, loop, and potassium-sparing diuretics) with subsequent risk of incident bone fractures using multivariable Cox regression models while minimizing confounding by indication using a target trial emulation approach. ResultsPatients were 63.3±12.9 years old; 93.5% (n=807,180) were male; and 27.1% (n=233,996) were diabetic. Their baseline estimated glomerular filtration rate was 84.4±16.5 mL/min per 1.73 m2. Among 863,339 patients, 424,386 (49.2%) newly initiated diuretics, of which 77.4% (n=328,524), 22.5% (n=95,457), and 0.1% (n=405) were thiazide, loop, and potassium-sparing diuretic users, respectively. After multivariable adjustments, incident diuretic use (vs non-use) was significantly associated with higher risk of incident fracture (adjusted HR [aHR], 1.14; 95% CI, 1.11 to 1.16). The association was most pronounced for loop diuretics (aHR, 1.39; 95% CI, 1.35 to 1.44) but less evident for thiazide diuretics (aHR, 1.08; 95% CI, 1.06 to 1.10) and was not significant for potassium-sparing diuretics (aHR, 0.97; 95% CI, 0.62 to 1.52). The diuretic-fracture association was more evident in younger (vs older) patients, those with (vs without) corticosteroid use, and those with lower (vs higher) serum sodium levels. ConclusionIncident use of diuretics, particularly loop diuretics, was independently associated with higher risk of incident bone fractures. Our findings suggest distinct pathophysiologic contributions of diuretics to bone metabolism and the need for careful attention to skeletal outcomes when initiating diuretics.

Addition of low sodium does not increase sensitivity to glucose in wild-type mice, or lead to partial glucose taste detection in T1R3 knock-out mice

The sodium glucose cotransporter 1 (SGLT1) has been proposed as a non-T1R glucosensor contributing to glucose taste. Studies have shown that the addition of NaCl at very weak concentrations to a glucose stimulus can enhance signaling in the gustatory nerves of mice and significantly lower glucose detection thresholds in humans. Here, we trained mice with (wild-type; WT) and without (knockout; KO) a functioning T1R3 subunit on a two-response operant detection task to differentially respond to the presence or absence of a taste stimulus immediately after sampling. After extensive training (∼40 sessions), KO mice were unable to reliably discriminate 2 M glucose+0.01 M NaCl from 0.01 M NaCl alone, but all WT mice could. We then tested WT mice on a descending array of glucose concentrations (2.0–0.03 M) with the addition of 0.01 M NaCl vs. 0.01 M NaCl alone. The concentration series was then repeated with glucose alone vs. water. We found no psychophysical evidence of a non-T1R taste transduction pathway involved in the detection of glucose. The addition of NaCl to glucose did not lower taste detection thresholds in WT mice, nor did it render the stimulus detectable to KO mice, even at 2 M. The proposed pathway must contribute to functions other than sensory-discriminative detection, at least when tested under these conditions. Detection thresholds were also derived for fructose and found to be 1/3 log10 lower than for glucose, but highly correlated (r = 0.88) between the two sugars, suggesting that sensitivity to these stimuli in this task was based on a similar neural process.

Long-Term Sodium Deficiency Reduces Sodium Excretion but Impairs Renal Function and Increases Stone Formation in Hyperoxaluric Calcium Oxalate Rats.

Excessive sodium intake is associated with nephrolithiasis, but the impact of sodium-deficient (SD) diets is unknown. Hence, we investigated the effects of short- and long-term SD diets on the expression of renal aquaporins and sodium transporters, and thus calcium oxalate (CaOx) crystal formation in hyperoxaluria rats. In a short-term sodium balance study, six male rats received drinking water and six received 0.75% ethylene glycol (EG) to induce hyperoxaluria. After a 30-day period of feeding on normal chow, both groups were treated with a normal-sodium diet for 5 days, followed by a sodium-free diet for the next 5 days. In a long-term SD study (42 days), four groups, induced with EG or not, were treated with normal-sodium water and sodium-free drinking water, alternately. Short-term sodium restriction in EG rats reversed the daily positive sodium balance, but progressively caused a negative cumulative water balance. In the long-term study, the abundant levels of of Na/H exchanger, thiazide-sensitive Na-Cl cotransporter, Na-K-ATPase, and aquaporins-1 from SD + EG rats were markedly reduced, corresponding to a decrease in Uosm, as compared to SD rats. Increased urine calcium, AP(CaOx)index, and renal CaOx deposition were also noted in SD + EG rats. Although the SD treatment reduced sodium excretion, it also increased urinary calcium and impaired renal function, ultimately causing the formation of more CaOx crystals.

The interaction between sodium to potassium intake and genetics to inform dietary management in hypertension

Blood pressure (BP) is influenced by both genetics and diet. Dietary management of hypertension includes increasing potassium-rich foods while reducing sodium intakes. Dietary sodium and potassium intakes can be measured objectively using urinary sodium and urinary potassium, with lower urinary sodium to potassium ratios associated with lower BP(1). Understanding the interplay between diet and genetics may be useful in treating hypertension and determining which individuals may receive an outsized benefit from lowering their sodium potassium ratio. This study aims to investigate whether identifying genetic risk for hypertension could be utilised to identify individuals who may benefit most from lowering sodium intake and increasing potassium intake. UK Biobank cohort participants (n = 296,475) with data on genotype, BP and spot urinary sodium and potassium data were used. Diet quality was assessed using Oxford WebQ. Biologically directed genetic scores for BP were constructed for pathways related to sodium/potassium biology (pharmagenic enrichment scores [PES]), as well as traditional polygenic risk scores (PRS). A gene-by-environment effect between urinary electrolytes, diet quality and PRS on BP were tested. Genetic risk, diet quality and urinary electrolytes independently correlated with BP. Urinary sodium had larger BP increasing effects amongst individuals who had high genetic risk in sodium/potassium pathways than those with comparatively lower genetic risk. Higher diet quality had a small effect on reducing BP in baseline PRS models, but this did not remain significant in the full model. Polygenic scores for BP personalised to individual sodium/potassium biology (PES) could be used to identify individuals who may receive an outsized benefit from a personalised sodium/potassium dietary intervention. These findings may inform future precision and personalised dietary advice for the management of hypertension.

Syndrome of Irreversible Lithium-Effectuated Neurotoxicity: Silent, but not innocent

IntroductionLithium is one of the main drugs used in Bipolar Affective Disorder. However, it has a narrow therapeutic window, which requires close monitoring and progressive dose adjustment, according to serum levels, clinical response and the appearance of side effects. The term ‘SILENT’ explains descriptively persistent neurological sequelae related to lithium salt intoxication when symptoms persist for more than 2 months after stopping treatment. SILENT Syndrome is more common in females, at ages ranging from 21 to 77 years and is characterized mainly by avermian-type cerebellar disorder, persistent extrapyramidal syndrome, brainstem dysfunction and dementia of varying severity. It can also result in apraxia of the body, changes in the coordination and balance, dysarthria, as well as intentional and kinetic cerebellar tremor, involuntary movements of orofacial dyskinesias or resting tremor.ObjectivesThe authors intend to review the relevant and current literature in order to extend the knowledge about this condition and find the best conducts for clinical practice.MethodsNon-systematic literature review.ResultsComplications from the use of lithium known in the medical literature include mainly nephrotoxicity, endocrine alterations and neurotoxicity. The neurotoxic effects of lithium usually occur at high serum concentrations. However, they can also occur with lithium in the therapeutic range, and memory, attention and ataxia impairment may be some of the permanent sequelae. The etiopathogenesis is unclear, but demyelination has been detected in multiple brain regions, mainly in the cerebellum. The mechanism of lithium-induced cerebellar injury is believed to be mediated by the entry of calcium into the cells of this organ. The main factors that predispose to greater side effects and risk of toxicity are patients with decreased renal function, advanced age, use of diuretics, dementia, pregnancy, low sodium intake and physical illness with vomiting and/or diarrhea.ConclusionsLithium is a drug used mostly in affective disorders and given the narrow therapeutic window, it requires close monitoring in order to avoid side effects that can be permanent. In this way, it is important to review the factors that increase the lithium toxicity and make recommendations about it.Disclosure of InterestNone Declared

Comparative assessment of hydrochemical characterization and groundwater quality for irrigation in an autochthonous karst aquifer with the support of GIS: case study of Altinova, Turkey

This study aims to present a comparative assessment of hydrochemical characterization and groundwater quality in karst aquifers with the support of GIS which is essential to correlate the source of water with climate and geology, and to evaluate suitability of water for various uses. The study area is the Altinova region in Turkey where intensive agricultural activities prevail and travertine covers 85% of the study area. A total of 25 groundwater wells were monitored by seasonal field measurements and extensive water quality analyses for a period of one year to establish correlation between groundwater quality, its source, regional climate, and geology. A comprehensive analysis was conducted to assess the groundwater's suitability for irrigation based on electrical conductivity, sodium adsorption ratio, sodium percentage, magnesium hazard, permeability index, residual sodium bicarbonate, Kelly’s ratio, and an irrigation water quality (IWQ) index. This multi-parameter evaluation was further integrated with geospatial analysis using ArcGIS, providing a detailed spatial understanding of hydrochemical variations across the area. Major cations and anions dominance were identified as Ca2+ > Na+ > Mg2+ > K+ and HCO3− > Cl− > SO42−, respectively. Spatial mapping identified high concentrations of Ca2+, TDS, TH, and SO42− in non-karstic areas, occasionally exceeding WHO guidelines. Nitrate concentrations displayed varied spatial distribution. The SAR values generally matched C2-S1 and C3-S1 classes, suggesting medium to high salinity risks and low sodium presence. Based on the IWQ index and observed correlations with total dissolved solids, the groundwater in Altinova’s karstic aquifer is considered suitable for irrigation, with salinization largely due to ionic interactions and geology. The presented comparative assessment provides a holistic approach for understanding hydrochemical characteristics of karst aquifers, and analyzing the impacts of natural factors and anthropogenic pollution sources on groundwater quality.

Synergistic Effect of 3D Electrode Architecture and In Situ Carbon Coating on the Electrochemical Performance of SnO2 Anodes for Sodium-Ion Batteries

SnO2, owing to its high theoretical capacity of 1378 mAh g−1 and low sodium insertion potential, is one of the attractive anode materials for Sodium-ion batteries (SIBs). However, extensive volume expansion (∼300 %), significant capacity loss, particle agglomeration, and low conductivity (1.82 × 10−8 S cm−1) of SnO2 limit its commercial applications. In this work, SnO2 nano-particles have been synthesized via a one-step hydrothermal method. Subsequently, 3D electrode architecture is developed using pitch-coated SnO2 nanomaterial onto carbon fiber (CF) current collector to mitigate the inherent challenges of SnO2 anode. Compared to the conventional SnO2 electrode, the optimized CF-SnO2- carbon composite electrodes show an excellent second-cycle stable capacity of 843 mAh g−1 at 30 mA g−1 with 95 % capacity retention after 100 cycles. This CF-SnO2-carbon composite electrode further delivers a stable capacity of 419 mAh g−1 at 300 mA g−1, having 80 % capacity retention after 200 cycles, and shows excellent C-rate performance. Conductive CF backbone and carbon coating accommodate the volume expansion of the active material, acting as a buffer matrix and reducing the electrode pulverization. This work entails a carbon fiber-based electrode engineering approach to fabricate a binder-less metal current collector-free freestanding electrode as a potential anode for SIBs.

Bioengineering of vascularized porcine flaps using perfusion-recellularization

Large volume soft tissue defects greatly impact patient quality of life and function while suitable repair options remain a challenge in reconstructive surgery. Engineered flaps could represent a clinically translatable option that may circumvent issues related to donor site morbidity and tissue availability. Herein, we describe the regeneration of vascularized porcine flaps, specifically of the omentum and tensor fascia lata (TFL) flaps, using a tissue engineering perfusion-decellularization and recellularization approach. Flaps were decellularized using a low concentration sodium dodecyl sulfate (SDS) detergent perfusion to generate an acellular scaffold with retained extracellular matrix (ECM) components while removing underlying cellular and nuclear contents. A perfusion-recellularization strategy allowed for seeding of acellular flaps with a co-culture of human umbilical vein endothelial cell (HUVEC) and mesenchymal stromal cells (MSC) onto the decellularized omentum and TFL flaps. Our recellularization technique demonstrated evidence of intravascular cell attachment, as well as markers of endothelial and mesenchymal phenotype. Altogether, our findings support the potential of using bioengineered porcine flaps as a novel, clinically-translatable strategy for future application in reconstructive surgery.

Joint Association of Low Nadir Serum Sodium and Potassium with Worse Outcomes after Ischemic Stroke

Background. Potassium and sodium are inextricably linked to the maintenance of cell potential and electrolyte homeostasis. Few studies have examined their joint relationship with outcomes after stroke. The objective of this study is to ascertain whether combined low nadir serum sodium and potassium levels are correlated with an unfavorable outcome in ischemic stroke. Methods. Retrospective cohort study of 2,920 consecutive patients with first-ever ischemic stroke. Serum sodium and potassium levels were measured at 10 consecutive time points over 10 days poststroke. The Youden Index was performed to identify patients with low nadir sodium (&lt;140 mmol/L) and potassium (&lt;3.65 mmol/L) levels, defined as a NaK score of 2. Multivariable logistic regression and Cox proportional hazard analysis were used to evaluate the independent relationship of sodium and potassium levels with clinical outcomes at three months. Results. A total of 2,920 patients with ischemic stroke were analyzed (mean age 62.14±14.13 years; 60.19% male), of whom 740 (25.3%) with both low nadir sodium and potassium levels had a quintuple 3-month case fatality compared to other patients (10.6% vs. 2.1%). Multivariable analyses identified NaK=2 as an independent predictor of 3-month death (adjusted odds ratio (OR) 2.23; 95% confidence interval (CI) 1.17-4.53; p=0.019) and an unfavorable shift in the distribution of scores on the modified Rankin scale (adjusted OR 1.51, 95% CI 1.12-2.04; p=0.007). Conclusions. Low sodium and potassium levels are common after ischemic stroke and are independent predictors of subsequent death.