Saline Dilution Research Articles

Comparative Analysis of Blood Transfusion Accuracy and Hemolysis Rate of Transfusion Cartridge Set Between Conventional Infusion Pumps and Cylinder-Type Infusion Pumps

Background: Infusion pumps are critical in delivering fluids, including medications and blood products, in controlled amounts. However, conventional pumps can cause hemolysis and other issues such as flow variations and infection risks, especially during blood transfusions. To address these limitations, a novel cylinder-type infusion pump, the Anyfusion H-100, was developed, which includes a specialized blood transfusion cartridge set that combines syringe and peristaltic infusion methods. This study evaluates the accuracy and hemolysis rates of the Anyfusion H-100 compared to conventional pumps, aiming to confirm its viability as a safe and effective medical device for blood transfusions. Methods: This study evaluated six different infusion rates (10–180 cc/hr) and conducted 57 transfusion trials, 20 of which used a 1:1 blood–saline dilution. Blood transfusion accuracy was measured using research-grade packed red blood cells, and hemolysis rates were assessed before and after transfusion by chi-square tests and independent sample t-tests. Results: Anyfusion demonstrated an average transfusion error rate of 3.77%, compared to 4.00% for the Terufusion, with no statistically significant difference in hemolysis rates (p = 0.697). Bland–Altman plots confirmed their equivalent performance, with hemolysis rates of 0.566 ± 0.095% for Anyfusion and 0.518 ± 0.126% for Terufusion. Conclusions: Anyfusion provides an accurate and reliable blood transfusion performance comparable to that of Terufusion, with no significant difference in hemolysis rates; its integration of syringe and infusion methods shows a potential for safer and more efficient transfusion practices, especially in pediatric and emergency settings.

Estimates of the Fugacity of CO2 in the Vridi Channel (Côte d’Ivoire)

From July to November 2023 and in April 2024, surface waters were collected at three separate sampling sites within the Vridi channel, to measure physical and chemical parameters such as salinity, temperature, pH, Dissolved Inorganic Carbon (DIC). The fCO2 and Total Alkalinity were calculated from pH and DIC. These surface waters were sampling during 4 seasons to study the variability of the carbonate system parameters. Low salinity and low temperature were observed in July -August because this period corresponded to high precipitation inducing salinity dilution and the appearance of coastal upwelling. High salinity and temperature were observed in a great dry season. In the whole, salinity and temperature have same trends of variability. Whatever the season, surface waters were oversaturated in fCO2 with respect to atmospheric equilibrium in the Vridi channel except in dry season. On average the fCO2 decreased from the great cold season to the hot season following marine season. Indeed, the high coastal upwelling appeared in July and disappeared in October. The variability of the channel fCO2 followed the upwelling events along the coastal areas. Moreover, parameters such as Total Alkalinity (TA), Dissolved Inorganic Carbon and pH undergone the influence of coastal upwelling as fCO2 in the Vridi channel.

Protective Effects of Huo Xiang Zheng Qi Liquid on Clostridioides difficile Infection on C57BL/6 Mice.

Clostridioides difficile-associated disease (CDAD) is a major healthcare-associated infection. New treatment options for CDAD are needed. A traditional Chinese medicinal formula, Huo Xiang Zheng Qi (HXZQ), was chosen to test against CDAD in a mouse model. C57BL/6 mice were challenged with C difficile (ATCC 43255) orally; then received saline; vancomycin 25 mg/kg; or HXZQ in two different concentrations twice daily for 5 days. The animals' body weight; clinical signs; and survival rates were registered daily. Fecal pellets from each animal were taken for PCR analysis as a control of infection. 50% of the mice receiving saline died; 85.7% of the mice receiving vancomycin survived; 75% of the mice receiving HXZQ survived; and 87.5% of the mice receiving a 1:1 saline dilution of HXZQ survived. The HXZQ-treated groups were C. difficile PCR positive with loads less than that of the untreated mice. The weight loss in the vancomycin plus HXZQ 1:1 treated group; the vancomycin-treated group; and the untreated group were 3.08%, 4.06%, and 9.62%, respectively. our results showed that HXZQ can protect mice from CDAD-related death as effectively as vancomycin and the combination of vancomycin and HXZQ may give even better protection.

Screening the Performance of a Reverse Osmosis Pilot-Scale Process That Treats Blended Feedwater Containing a Nanofiltration Concentrate and Brackish Groundwater.

A two-stage pilot plant study has been completed that evaluated the performance of a reverse osmosis (RO) membrane process for the treatment of feedwater that consisted of a blend of a nanofiltration (NF) concentrate and brackish groundwater. Membrane performance was assessed by monitoring the process operation, collecting water quality data, and documenting the blended feedwater's impact on fouling due to microbiological or organic means, plugging, and scaling, or their combination. Fluorescence and biological activity reaction tests were used to identify the types of organics and microorganisms present in the blended feedwater. Additionally, scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were used to analyze suspended matter that collected on the surfaces of cartridge filters used in the pilot's pretreatment system. SEM and EDS were also used to evaluate solids collected on the surfaces of 0.45 µm silver filter pads after filtering known volumes of NF concentrate and RO feedwater blends. Water quality analyses confirmed that the blended feedwater contained little to no dissolved oxygen, and a significant amount of particulate matter was absent from the blended feedwater as defined by silt density index and turbidity measurements. However, water quality results suggested that the presence of sulfate, sulfide, iron, anaerobic bacteria, and humic acid organics likely contributed to the formation of pyrite observed on some of the membrane surfaces autopsied at the conclusion of pilot operations. It was determined that first-stage membrane productivity was impacted by the location of cartridge filter pretreatment; however, second-stage productivity was maintained with no observed flux decline during the entire pilot operation's timeline. Study results indicated that the operation of an RO process treating a blend of an NF concentrate and brackish groundwater could maintain a sustainable and productive operation that provided a practical minimum liquid discharge process operation for the NF concentrate, while the dilution of RO feedwater salinity would lower overall production costs.

Assessment of change in the basic variants composition of trastuzumab during dilution in saline for administration

Postproduction handling of drug products during preparation or clinical use may affect the structure and efficacy of the drug and perhaps remain unnoticed. Since chemical modifications can impact the product's structure, stability, and biological activity, this study investigates the impact of elevated temperature and subtle shift in pH on the drug product post-dilution in saline. The mAb sample diluted in saline for administration was stressed at elevated temperature and slightly acidic pH condition. Extended stability studies were performed and monitored for size and charge heterogeneity. Size heterogeneity shows no significant changes, whereas charge heterogeneity shows an increase in basic variants and a reduction in main species. Further, basic variants were isolated and characterized to identify the type and site of chemical modification. Intact mass analysis and peptide mapping identify that the basic variants were attributed mainly to the isomerization of HC Asp102 into iso-Asp or its succinimide intermediate. Four basic variants were found to exhibit similar structural properties as the main and control samples. However, basic variants showed reduced binding affinity to HER2 receptor, while there was no significant difference in FcRn binding. The results indicate that modification in the HC Asp102, which is present in the CDR, affects antigen binding and thus can influence the potency of the drug product. Hence, with the conventional stability studies required to license the drug product, including in-use or extended stability studies to mimic the postproduction handling would be desirable.

A half-cell reaction approach for pH calculation using a solid-state chloride ion-selective electrode with a hydrogen ion-selective ion-sensitive field effect transistor

Here, we explicitly define a half-cell reaction approach for pH calculation using the electrode couple comprised of the solid-state chloride ion-selective electrode (Cl-ISE) as the reference electrode and the hydrogen ion-selective ion-sensitive field effect transistor (ISFET) of the Honeywell Durafet as the hydrogen ion H+-sensitive measuring or working electrode. This new approach splits and isolates the independent responses of the Cl-ISE to the chloride ion Cl− (and salinity) and the ISFET to H+ (and pH), and calculates pH directly on the total scale pHtotalEXT in molinity (mol (kg-soln)−1) concentration units. We further apply and compare pHtotalEXT calculated using the half-cell and the existing complete cell reaction (defined by Martz et al. (2010)) approaches using measurements from two SeapHOx sensors deployed in a test tank. Salinity (on the Practical Salinity Scale) and pH oscillated between 1 and 31 and 6.9 and 8.1, respectively, over a six-day period.In contrast to established Sensor Best Practices, we employ a new calibration method where the calibration of raw pH sensor timeseries are split out as needed according to salinity. When doing this, pHtotalEXT had root-mean squared errors ranging between ±0.0026 and ±0.0168 pH calculated using both reaction approaches relative to pHtotal of the discrete bottle samples pHtotaldisc. Our results further demonstrate the rapid response of the Cl-ISE reference to variable salinity with changes up to ±12 (30 min)−1. Final calculated pHtotalEXT were ≤±0.012 pH when compared to pHtotaldisc following salinity dilution or concentration. These results are notably in contrast to those of the few in situ field deployments over similar environmental conditions that demonstrated pHtotalEXT calculated using the Cl-ISE as the reference electrode had larger uncertainty in nearshore waters. Therefore, additional work beyond the correction of variable temperature and salinity conditions in pH calculation using the Cl-ISE is needed to examine the effects of other external stimuli on in situ electrode response. Furthermore, whereas past work has focused on in situ reference electrode response, greater scrutiny of the ISFET as the H+-sensitive measuring electrode for pH measurement in natural waters is also needed.

Are dilution, slow injection and care bolus technique the causal solution to mitigating arterial-phase artifacts on gadoxetic acid–enhanced MRI? A large-cohort study

ObjectiveArterial-phase artifacts are gadoxetic acid (GA)–enhanced MRI’s major drawback, ranging from 5 to 39%. We evaluate the effect of dilution and slow injection of GA using automated fluoroscopic triggering on liver MRI arterial-phase (AP) acquisition timing, artifact frequency, and lesion visibility.Methods and materialsSaline-diluted 1:1 GA was injected at 1 ml/s into 1413 patients for 3 T liver MRI. Initially, one senior abdominal radiologist, i.e., principal investigator (PI), assessed all MR exams and compared them to previous and follow-up images, as well as the radiology report on record, determining the standard of reference for lesion detection and characterization. Then, three other readers independently evaluated the AP images for artifact type (truncation (TA), transient severe motion (TSM) or mixed), artifact severity (on a 5-point scale), acquisition timing (on a 4-point scale) and visibility (on a 5-point scale) of hypervascular lesions ≥ 5 mm, selected by the PI. Artifact score ≥ 4 and artifact score ≤ 3 were considered significant and non-significant artifacts, respectively.ResultsOf the 1413 exams, diagnostic-quality arterial-phase images included 1100 (77.8%) without artifacts, 220 (15.6%) with minimal, and 77 (5.4%) with moderate artifacts. Only 16 exams (1.1%) had significant artifacts, 13 (0.9%) with severe artifacts (score 4), and three (0.2%) non-diagnostic artifacts (score 5). AP acquisition timing was optimal in 1369 (96.8%) exams. Of the 449 AP hypervascular lesions, 432 (96.2%) were detected.ConclusionCombined dilution and slow injection of GA with MR results in well-timed arterial-phase images in 96.8% and a reduction of exams with significant artifacts to 1.1%.Clinical relevance statementHypervascular lesions, in particular HCC detection, hinge on arterial-phase hyperenhancement, making well-timed, artifact-free arterial-phase images a prerequisite for accurate diagnosis. Saline dilution 1:1, slow injection (1 ml/s), and automated bolus triggering reduce artifacts and optimize acquisition timing.Key Points• There was substantial agreement among the three readers regarding the presence and type of arterial-phase (AP) artifacts, acquisition timing, and lesion visibility.• Impaired AP hypervascular lesion visibility occurred in 17 (3.8%) cases; in eight lesions due to mistiming and in nine lesions due to significant artifacts.• When AP timing was suboptimal, it was too late in 40 exams (3%) and too early in 4 exams (0.2%) of exams.

Comparative Analysis of AB vs. ABO-specific Plasma for Desensitization in Blood Group O Recipients: An In Vitro Study.

Neutralizing capacity measurement (NCM) of soluble ABH substances (SAS) in plasma was assessed to guide the selection of the appropriate ABO group of fresh-frozen plasma (FFP) for plasma exchange (PE) in blood group O recipients with ABO-incompatible transplantations. Neutralizing capacity was assessed by measuring anti-A and/or anti-B titers in samples comprising one unit of O FFP and 10 O EDTA plasma samples and subtracting the binary logarithm of the titer in each group with a saline dilution. Ten EDTA plasma samples with Lewis b (Leb) antigen positivity and 10 sets of pooled FFP from each blood group were used as diluents. In O FFP, the NCM values (mean±SD) were 3.4±0.52 (2.6±0.52) and 2.6±0.52 (1.5±0.3) in B and AB for IgM (total antibody) anti-B (both P<0.001), and in the 10 O EDTA plasma samples, they were 3.9±0.88 (3.1±0.88) and 3.2±0.79 (2.4±0.97) for IgM (P=0.0013) and total anti-B (P=0.025), respectively. In vitro analysis revealed that B FFP is more effective than AB FFP in reducing IgM and total anti-B antibody titers in O recipients, regardless of Leb antigen positivity.

Dilution of Salinity Using Rainwater Harvesting System - An Innovative Approach

In view of the increasing water demand, this paper recognizes rainwater harvesting as an innovative approach to the dilution of salinity. It proposes dilution of salinity to reduce both the direct and indirect effects of salinity on human health and well-being. This paper focuses on the saline regions of the Union Territory of Delhi. It identifies possibilities for salinity dilution by proposing an innovative approach to implement rainwater harvesting. For this purpose, this paper evaluates the rooftop rainwater harvesting potential for roof area including 100, 200, 300, 400 and 500 square meter area, in the identified saline regions of National Capital Territory (NCT) Delhi. To assess the impact of the rainwater harvesting system on salinity dilution, different maps and data were analysed. These maps include a salinity map of Delhi, a depth-to-water level map of Delhi, water level fluctuation map of Delhi, isohytal map of Delhi, etc.

Prolonging the stability of cetuximab (Erbitux®) and panitumumab (Vectibix®): An orthogonal assessment of physicochemical, biological and microbiological properties of original opened glass vials and diluted saline preparations

The two anti-epidermal growth factor receptor monoclonal antibodies (mAbs) cetuximab and panitumumab are the pillars for the treatment of EGFR-positive, KRAS wild-type metastatic colorectal cancers. However, stability data of these mAbs are generally missing or incomplete. Here, we report for the first time an orthogonal analysis of the stability of cetuximab (Erbitux®) and panitumumab (Vectibix®), either undiluted vial leftovers or saline dilutions in polyolefin/polyamide infusion bags. All samples were stored at 2–8 °C protected from light, according to their summary of product characteristics (SmPCs). Alternatively, opened vials and preparations were maintained at 25 °C for 15 h, and then stored again at 2–8 °C protected from light to mimic a temporary interruption of the cold chain. Vial leftovers proved stable up to 180 days when stored according to their SmPCs, while compounded preparations in infusion bags maintained their physiochemical, biological and microbiological stability up to 30 days. Additionally, no changes were detected up to 30 days for the same samples undergoing a thermal excursion. Our results provide additional rationale to the SmPCs, crucial especially in the case of reassignment and pre-preparation of bags. This information will allow hospitals to achieve significant cost savings, and better organization of the entire therapeutic process.

Improving timely melphalan administration completion for recipients of autologous stem cell transplant.

372 Background: Melphalan hydrochloride is a primary agent used in the conditioning regimen for autologous stem cell transplant indications including multiple myeloma and lymphoma. Brand Alkeran labelling indicates the drug concentration must not exceed 0.45 mg/mL and should be given over a minimum 15 minutes but infused in its entirety within 60 minutes from preparation. Caution is provided as data has shown a loss of potency by 1% every 10 minutes after melphalan dilution. Time and concentration constraints often require the dose being divided into two infusion bags with the option to Y-site. These limitations necessitated an optimized process to ensure melphalan completion within the 60-minute timeframe. Methods: Our institution began to formally audit melphalan administration data in November 2018 as part of a new program quality metric. A retrospective evaluation was performed which assessed the total time from melphalan dilution in a normal saline (NS) bag to melphalan infusion completion. The aim was to increase compliance within 60 minutes from 86.2% to 100%. We utilized the Plan-Do-Study-Act (PDSA) cycle method to address opportunities for improvement. PDSA 1 included staff education on the importance of timely administration; same-day audit forms were created to dissect any potential fallouts promptly. This form included documentation of the time from vial reconstitution to delivery to the pharmacist within the patient care unit. Secondary to re-evaluation of package insert verbiage and discussion with the manufacturer, we redefined the audit start time to be melphalan vial reconstitution instead of dilution in the infusion bag. PDSA 2 incorporated specific checkpoints for vial reconstitution (12 minutes) and bag delivery (20 minutes) and changed from concurrent to sequential bag administration. Results: A total 285 melphalan infusions were eligible for analysis (mean 1.91 bags per patient). Baseline data showed 86.2% of infusions completed within the 60-minute timeframe. Average time-to-completion was 50.2 minutes (N=73). PDSA 1 revealed 100% compliance of chemotherapy verification documentation and 97.9% infusion completion with an average time of 42.8 minutes (N=97). PDSA 2 resulted 99.1% compliance (one infusion fallout) and an average completion time of 41.2 minutes (N=115). Overall survival (OS) at 1-year for baseline, PDSA 1, and PDSA 2 groups was 94.7%, 95.9%, and 98.3% respectively ( p=0.66). Conclusions: The outcome measure average and mean time-to-completion improved from 86.2% to 99.1% and 50.2 to 41.2 minutes, respectively, secondary to process measure implementation despite the more stringent redefined vial dilution start time. A lone fallout of 62 minutes in PDSA 2 was triaged and determined to be due to unpredictable line complications. No significant differences in OS were observed. Ultimately, our process was optimized in terms of both compliance and efficiency.

Quartz Crystal Microbalance as a Predictive Tool for Drug-Material of Construction Interactions in Intravenous Protein Drug Administration

As a growing number of protein drug products are developed, formulation characterization is becoming important. An IgG drug product is tested at concentrations from 0.0001–0.1 mg/mL for adsorption behavior to polymer surfaces polyvinyl chloride (PVC) and polypropylene (PP) upon dilution in normal saline (NS) using quartz crystal microbalance with dissipation (QCM-D). The studies mimicked IgG antibody interaction during IV administration with polymeric surfaces within syringes, lines, and bags. Drug product was characterized with excipients, with focus on surfactant. Drug solutions were run over polymer-coated sensors to measure the adsorption behavior of the formulation with emphasis on the behavior of each of the formulation's components. Over 60 sensorgram data sets were correlated with assayed protein solution concentrations in mock NS-diluted infusions of drug product in the equivalent concentrations to QCM experiments to build a preliminary predictive model for determining fraction of drug and surfactant adsorbed and lost at the hydrophobic surface during administration. These results create a method for reliably and predictively estimating drug product adsorption behavior and protein drug dose loss on polymers at different protein drug concentrations.

Membrane-based therapeutic plasma exchange: Proposed techniques for preventing filter failure.

Therapeutic plasma exchange (TPE) is commonly performed using membrane-based TPE (mTPE) and is prone to filter failure. We report on 46 patients, with a total of 321 mTPE treatments using the NxStage machine. This was a retrospective study with an aim to evaluate the effect of heparin, pre-filter saline dilution and the impact of total plasma volume exchanged (< 3 L vs. ≥3 L) on the rate of filter failure. Primary outcome was the overall rate of filter failure. Secondary outcomes included factors that may have indirectly influenced the rate of filter failure, including hematocrit, platelet count, replacement fluid (Fresh Frozen Plasma vs. albumin), and access type. We found that treatments that received both pre-filter heparin and saline had a statistically significant decrease in filter failure rate as compared to those that received neither (28.6% vs. 5.3%, P = .001), and compared to the treatments that received pre-filter heparin alone (14.2% vs. 5.3%, P = .015). In treatments that received both pre-filter heparin and saline predilution, we noted a significantly higher filter failure rate when the plasma volume exchanged was ≥3 L as compared to those that had <3 L exchanged (12.2% vs. 0.9%, P = .001). Rate of filter failure in mTPE can be reduced by implementing several therapeutic interventions including pre-filter heparin and pre-filter saline solution. These interventions were not associated with any clinically significant adverse events. Despite the above-mentioned interventions, large plasma volume exchanges of ≥3 L can negatively impact filter life.

The investigation of antibacterial activity of hyperlight fluid fusion subcellular essential complex.

This study aimed to investigate the possibility of applying the hyperlight fluid fusion essential complex in dental plaque control, and to evaluate the effectiveness of new and modern agents used for the prevention and early treatment of gingivitis. The study included 60 subjects randomly divided into two groups. The control group was assigned to 0.12% chlorhexidine (CHX) mouth rinse, whereas the test group used a solution based on hyper-harmonized hydroxylated fullerene water complex (3HFWC), twice daily for 2 weeks. The plaque, gingivitis and bleeding scores were evaluated and recorded. Collected plaque samples were seeded on blood agar and incubated aerobically at a temperature of 37 °C for 24-48 hours. In order to isolate anaerobic bacteria, samples were seeded on Schaedler Agar and incubated anaerobically at 37 °C for seven days. Serial dilutions in saline from 101 - 106 were made, and grown colonies were counted and identified using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) system. The reduction in the number of bacteria was significant in both control and test groups. The reduction was greater in the control group compared to the experimental group, but without statistically significant difference. 3HFWC treatment causes significant reduction in the number of dental plaque microorganisms. Since 3HFWC solution exhibited a bacteriostatic effect similar to chlorhexidine it could be an adequate addition to solution of a growing problem in prevention and early treatment of gingivitis and periodontitis.

Spatially distributed water quality responses to freshwater discharge in a tropical estuary, Hilo Bay, Hawai'i.

Hilo Bay, Hawai'i, is an estuary of great importance to its neighboring coastal community, but it is threatened by impaired water quality indicated by excessive turbidity and chlorophyll a associated with river discharges of sediments and nutrients. The Wailuku River in the western half of the bay is the primary source of freshwater discharge, hypothesized here to form a surface water-dominant half of the bay with different water quality traits than the groundwater-dominant, eastern half of the bay where the spring-fed Wailoa River discharges. The water quality of both halves of the bay over different flow conditions of the Wailuku River is examined in this study using spatially distributed water quality sampling which collects hundreds of samples in either half of the bay at a distance of about every 40m. The dense sample shows significant differences between the two halves of the bay, with greater salinity dilution and turbidity in the surface water-dominant area. Both salinity and turbidity have a predictable relation to discharge, with salinity decreasing and turbidity increasing in higher flow conditions. Chlorophyll a, however, has a more complex relation to discharge, as chlorophyll a concentrations are greatest in high-flow conditions, but this may be because the water quality samples were collected in different seasons. Furthermore, significantly greater chlorophyll a concentrations in the groundwater-dominant half of the bay in low-flow conditions show that discharge may be spuriously correlated to chlorophyll a, and further studies of the effects of surface water discharge on chlorophyll a concentrations are warranted.

Habitat compression of an estuarine mytilid following half a century of streamflow decline

The distribution of species throughout estuaries is often regulated by salinity gradients, among other key environmental drivers. In many temperate estuaries, however, declining streamflow has led to increased marinization and thus potential habitat compression of some species. Since the mid-1970s, estuaries in south-western Australia have experienced among the greatest decline in streamflow in Australia due to a drying and warming climate. The resultant habitat modification would be particularly unfavourable to sessile fauna, such as mytilid mussels, which are unable to relocate due to their attachment to substrate via byssal threads. This study compared the settlement (and adult survival) of Black Pygmy Mussel Xenostrobus securis in the Swan-Canning Estuary with that described in this system sixty years earlier, over which time freshwater discharge declined by >50%. During the 1960s, settlement of X. securis occurred throughout much of the estuary, beginning in the estuary basin in November and in the upper Swan River in February/March as winter freshwater flow subsided and salinities increased. In contrast, in the current study (2019/2020), X. securis settlement was largely restricted to the upper zones of the estuary. Settlement of X. securis larvae also began much earlier, occurring in the upper Swan River in October, compared with February/March during the 1960s. This is consistent with the salinity tolerances of larval X. securis and declining streamflow, leading to increased marinization of the estuary basin and earlier encroachment of the salt-wedge upstream. In addition, the increased frequency of summer streamflow events in recent decades makes X. securis populations even more vulnerable to substantial mortalities caused by rapid dilution of salinity at warmer temperatures. Thus, the combination of habitat compression, from declining streamflow and increased occurrence of extreme summer rainfall events are likely to pose substantial problems for the survival of X. securis populations in this region into the future. The results of this study further our knowledge on the potential impacts of environmental change on sessile fauna and is of interest to environmental managers.

Hypertonic saline dilution: a simple technique to offset interference of IGM paraproteins in uric acid analysis

Background: The presence of paraproteins, particularly IgM, can cause interference in many biochemical assays, including uric acid. For some paraproteins, interference may derive from their propensity to precipitate, depending on the ionic strength of the assay reaction.

DYT30 due to VPS16 Mutation: An Etiology of Childhood-Onset Generalized Dystonia.

DYT30 due to VPS16 Mutation: An Etiology of Childhood-Onset Generalized Dystonia.

NUCLEAR FACTOR-ERYTHROID-2-RELATED FACTOR REGULATES SYSTEMIC AND PULMONARY BARRIER FUNCTION AND IMMUNE PROGRAMMING AFTER BURN AND INHALATION INJURY.

Major burn injury is associated with systemic hyperinflammatory and oxidative stresses that encompass the wound, vascular, and pulmonary systems that contribute to complications and poor outcomes. These stresses are exacerbated if there is a combined burn and inhalation (B+I) injury, which leads to increases in morbidity and mortality. Nuclear factor-erythroid-2-related factor (NRF2) is a transcription factor that functions to maintain homeostasis during stress, in part by modulating inflammation and oxidative injury. We hypothesized that the NRF2-mediated homeostasis after burn alone and combined B-I injury is insufficient, but that pharmacological activation of the NRF2 pathway has the potential to reduce/reverse acute hyper inflammatory responses. We found that, after burn and B+I injury, Nrf2 -/- mice have higher mortality and exhibit greater pulmonary edema, vascular permeability, and exacerbated pulmonary and systemic proinflammatory responses compared with injured wild-type (WT) controls. Transcriptome analysis of lung tissue revealed specific Nrf2 -dependent dysregulated immune pathways after injury. In WT mice, we observed that B+I injury induces cytosolic, but not nuclear, accumulation of NRF2 protein in the lung microenvironment compared with sham-injured controls. Bardoxolone methyl (CDDO-Me)-containing microparticles (CDDO-MPs) were developed that allow for dilution in saline and stable release of CDDO-Me. When delivered intraperitoneally into mice 1 hour after B+I injury, CDDO-MPs significantly reduced mortality and cytokine dysfunction compared with untreated B-I animals. These data implicate the role of NRF2 regulation of pulmonary and systemic immune dysfunction after burn and B+I injury, and also a deficiency in controlling immune dysregulation. Selectively activating the NRF2 pathway may improve clinical outcomes in burn and B+I patients.

Topical Neck Cooling Attenuates Inflammatory Responses and Sepsis Progression in Intra-abdominal Sepsis

INTRODUCTION: Advances in therapies to treat sepsis beyond source control, antibiotics, and supportive care are lacking. Systemic hypothermia has been suggested but remains difficult to implement. Using a swine model of intra-abdominal sepsis, we hypothesize that topical neck cooling (TNC) can inhibit inflammation to preserve organ function and prolong the therapeutic window for intervention via a vagus nerve–mediated pathway. METHODS: Domestic pigs underwent laparotomy and induction of severe feculent peritonitis (FP) by extraction of autologous stool (2 g/kg swine weight) via colotomy, dilution in saline, and subsequent injection into the peritoneal cavity. Pigs were randomized to control and TNC groups, with TNC applied to the ventral neck for a 2-hour period 30 minutes after FP. Hemodynamic monitoring and serial bloodwork was performed for 6 hours. Organs were then harvested. RESULTS: TNC significantly attenuated FP-induced tachycardia by 127% (54% ± 8% increase from TNC baseline vs 181% ± 44% increase from control baseline, p < 0.05). Metabolic acidosis and lactic acidemia at 6 hours were significantly increased from pre-septic baseline in control pigs (pH 7.29 ± 0.03 vs pH 7.41 ± 0.03 and 2.42 ± 0.40 mmol/L vs 0.61 ± 0.22 mmol/L, respectively, p < 0.05), but not in TNC-treated pigs. Proinflammatory cytokines IL-1β and IL-6 were significantly reduced by TNC treatment (p < 0.05; Figure).Figure.: FP, feculent peritonitis; TNC, topical neck cooling.CONCLUSION: In a swine model of severe FP, TNC significantly inhibited FP-induced severe tachycardia, potentially via vagal activation. TNC also improved tissue perfusion and metabolic acidosis and inhibited proinflammatory responses. TNC is an easily implemented novel therapy that can potentially delay sepsis progression and extend the therapeutic window for surgical source control.