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1.
The effectiveness of a saline mouth rinse regimen and education programme on radiation-induced oral mucositis and quality of life in oral cavity cancer patients: A randomised controlled trial.
Huang, BS, Wu, SC, Lin, CY, Fan, KH, Chang, JT, Chen, SC
European journal of cancer care. 2018;(2):e12819
Abstract
Radiation therapy (RT) and concurrent chemotherapy RT (CCRT) generate radiation-induced oral mucositis (OM) and lower quality of life (QOL). This study assessed the impact of a saline mouth rinse regimen and education programme on radiation-induced OM symptoms, and QOL in oral cavity cancer (OCC) patients receiving RT or CCRT. Ninety-one OCC patients were randomly divided into a group that received saline mouth rinses and an education programme and a control group that received standard care. OM symptoms and QOL were assessed with the WHO Oral Toxicity Scale, MSS-moo and UW-QOL. Data were collected at the first postoperative visit to the radiation department (T0) and at 4 weeks and 8 weeks after beginning RT or CCRT. Patients in both groups had significantly higher levels of physical and social-emotional QOL at 8 weeks after beginning RT or CCRT compared to the first visit. Patients in the saline rinse group had significantly better physical and social-emotional QOL as compared to the standard care group at 8 weeks. Radiation-induced OM symptoms and overall QOL were not different between the groups. We thus conclude the saline rinse and education programme promote better physical and social-emotional QOL in OCC patients receiving RT/CCRT.
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Normal saline for intravenous fluid therapy in critically ill patients.
Zhou, FH, Liu, C, Mao, Z, Ma, PL
Chinese journal of traumatology = Zhonghua chuang shang za zhi. 2018;(1):11-15
Abstract
The efficacy and safety of normal saline (NS) for fluid therapy in critically ill patients remain controversy. In this review, we summarized the evidence of randomized controlled trials (RCTs) which compared NS with other solutions in critically ill patients. The results showed that when compared with 6% hydroxyethyl starch (HES), NS may reduce the onset of acute kidney injury (AKI). However, there is no significant different in mortality and incidence of AKI when compared with 10% HES, albumin and buffered crystalloid solution. Therefore, it is important to prescribe intravenous fluid for patients according to their individual condition.
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Balanced Crystalloids versus Saline in Critically Ill Adults.
Semler, MW, Self, WH, Wanderer, JP, Ehrenfeld, JM, Wang, L, Byrne, DW, Stollings, JL, Kumar, AB, Hughes, CG, Hernandez, A, et al
The New England journal of medicine. 2018;(9):829-839
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Abstract
BACKGROUND Both balanced crystalloids and saline are used for intravenous fluid administration in critically ill adults, but it is not known which results in better clinical outcomes. METHODS In a pragmatic, cluster-randomized, multiple-crossover trial conducted in five intensive care units at an academic center, we assigned 15,802 adults to receive saline (0.9% sodium chloride) or balanced crystalloids (lactated Ringer's solution or Plasma-Lyte A) according to the randomization of the unit to which they were admitted. The primary outcome was a major adverse kidney event within 30 days - a composite of death from any cause, new renal-replacement therapy, or persistent renal dysfunction (defined as an elevation of the creatinine level to ≥200% of baseline) - all censored at hospital discharge or 30 days, whichever occurred first. RESULTS Among the 7942 patients in the balanced-crystalloids group, 1139 (14.3%) had a major adverse kidney event, as compared with 1211 of 7860 patients (15.4%) in the saline group (marginal odds ratio, 0.91; 95% confidence interval [CI], 0.84 to 0.99; conditional odds ratio, 0.90; 95% CI, 0.82 to 0.99; P=0.04). In-hospital mortality at 30 days was 10.3% in the balanced-crystalloids group and 11.1% in the saline group (P=0.06). The incidence of new renal-replacement therapy was 2.5% and 2.9%, respectively (P=0.08), and the incidence of persistent renal dysfunction was 6.4% and 6.6%, respectively (P=0.60). CONCLUSIONS Among critically ill adults, the use of balanced crystalloids for intravenous fluid administration resulted in a lower rate of the composite outcome of death from any cause, new renal-replacement therapy, or persistent renal dysfunction than the use of saline. (Funded by the Vanderbilt Institute for Clinical and Translational Research and others; SMART-MED and SMART-SURG ClinicalTrials.gov numbers, NCT02444988 and NCT02547779 .).
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Randomized trial of one-hour sodium bicarbonate vs standard periprocedural saline hydration in chronic kidney disease patients undergoing cardiovascular contrast procedures.
Kooiman, J, de Vries, JPM, Van der Heyden, J, Sijpkens, YWJ, van Dijkman, PRM, Wever, JJ, van Overhagen, H, Vahl, AC, Aarts, N, Verberk-Jonkers, IJAM, et al
PloS one. 2018;(2):e0189372
Abstract
BACKGROUND Guidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures. METHODS We performed an open-label multicentre non-inferiority trial between 2011-2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48-96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44μmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up. RESULTS Mean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001). CONCLUSION Short hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings. TRIAL REGISTRATION Netherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699.
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Protective Strategies Against Dysphonia in Teachers: Preliminary Results Comparing Voice Amplification and 0.9% NaCl Nebulization.
Masson, MLV, de Araújo, TM
Journal of voice : official journal of the Voice Foundation. 2018;(2):257.e1-257.e10
Abstract
OBJECTIVE This study aimed to compare the effects of two protective strategies, voice amplification (VA) and 0.9% NaCl nebulization (NEB), on teachers' voice in the work setting. METHODS An interventional evaluator-blind study was conducted, assigning 53 teachers from two public high schools to one of the two protective strategy groups (VA or NEB). Vocal function was assessed in a sound-treated booth before and after a 4-week period. Assessment included the severity of voice impairment (Consensus Auditory-Perceptual Evaluation of Voice [CAPE-V]), acoustic analysis of fundamental frequency (f0), sound pressure level (SPL), jitter, shimmer, glottal-to-noise excitation ratio (GNE), noise (VoxMetria), and the self-rated Screening Index for Voice Disorder (SIVD). Data were statistically analyzed using SPSS Statistics (version 22) with a significance level of P ≤ 0.05. Effect size was calculated using Cohen's d coefficient. RESULTS There were no statistical differences between groups at baseline in terms of age, sex, time of teaching, teaching workload, and voice outcomes, except for SPL. During postintervention between groups, NEB displayed lower SIVD scores (VA = 3; NEB = 0; P = 0.018) and VA had lower acoustic irregularity (VA = 3.19; NEB = 3.69; P = 0.027), with moderate to large effect size. Postintervention within-groups decreased CAPE-V for VA (pretest = 31.97; posttest = 28.24; P = 0.021) and SIVD for NEB (pretest = 3; posttest = 0; P = 0.001). SPL decreased in both groups, NEB decreased in men only, and VA decreased in both men and women. NEB increased f0 for female participants (P ≤ 0.001). CONCLUSION Both VA and NEB may help mitigate dysphonia in different pathways, being potential interventions for protecting teachers' voices in the work setting. An ongoing study with a control group will further support these preliminary results.
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High light aggravates functional limitations of cucumber canopy photosynthesis under salinity.
Chen, TW, Stützel, H, Kahlen, K
Annals of botany. 2018;(5):797-807
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Abstract
BACKGROUND AND AIMS Most crop species are glycophytes, and salinity stress is one of the most severe abiotic stresses reducing crop yields worldwide. Salinity affects plant architecture and physiological functions by different mechanisms, which vary largely between crop species and determine the susceptibility or tolerance of a crop species to salinity. METHODS Experimental data from greenhouse cucumber (Cucumis sativus), a salt-sensitive species, grown under three salinity levels were interpreted by combining a functional-structural plant model and quantitative limitation analysis of photosynthesis. This approach allowed the quantitative dissection of canopy photosynthetic limitations into architectural and functional limitations. Functional limitations were further dissected into stomatal (Ls), mesophyll (Lm) and biochemical (Lb). KEY RESULTS Architectural limitations increased rapidly after the start of the salinity treatment and became stronger than the sum of functional limitations (Ls + Lm + Lb) under high salinity. Stomatal limitations resulted from ionic effects and were much stronger than biochemical limitations, indicating that canopy photosynthesis was more limited by the effects of leaf sodium on stomatal regulation than on photosynthetic enzymes. Sensitivity analyses suggested that the relative importance of salinity effects on architectural and functional limitations depends on light conditions, with high light aggravating functional limitations through salinity effects on stomatal limitations. CONCLUSIONS Salinity tolerance of cucumber is more likely to be improved by traits related to leaf growth and stomatal regulation than by traits related to tissue tolerance to ion toxicity, especially under high light conditions.
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The novel EHEC gene asa overlaps the TEGT transporter gene in antisense and is regulated by NaCl and growth phase.
Vanderhaeghen, S, Zehentner, B, Scherer, S, Neuhaus, K, Ardern, Z
Scientific reports. 2018;(1):17875
Abstract
Only a few overlapping gene pairs are known in the best-analyzed bacterial model organism Escherichia coli. Automatic annotation programs usually annotate only one out of six reading frames at a locus, allowing only small overlaps between protein-coding sequences. However, both RNAseq and RIBOseq show signals corresponding to non-trivially overlapping reading frames in antisense to annotated genes, which may constitute protein-coding genes. The transcription and translation of the novel 264 nt gene asa, which overlaps in antisense to a putative TEGT (Testis-Enhanced Gene Transfer) transporter gene is detected in pathogenic E. coli, but not in two apathogenic E. coli strains. The gene in E. coli O157:H7 (EHEC) was further analyzed. An overexpression phenotype was identified in two stress conditions, i.e. excess in salt or arginine. For this, EHEC overexpressing asa was grown competitively against EHEC with a translationally arrested asa mutant gene. RT-qPCR revealed conditional expression dependent on growth phase, sodium chloride, and arginine. Two potential promoters were computationally identified and experimentally verified by reporter gene expression and determination of the transcription start site. The protein Asa was verified by Western blot. Close homologues of asa have not been found in protein databases, but bioinformatic analyses showed that it may be membrane associated, having a largely disordered structure.
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Defining Dogma: Quantifying Crystalloid Hemodilution in a Prospective Randomized Control Trial with Blood Donation as a Model for Hemorrhage.
Ross, SW, Christmas, AB, Fischer, PE, Holway, H, Seymour, R, Huntington, CR, Heniford, BT, Sing, RF
Journal of the American College of Surgeons. 2018;(3):321-331
Abstract
BACKGROUND The concept of hemodilution after blood loss and crystalloid infusion is a surgical maxim that remains unproven in humans. We sought to quantify the effect of hemodilution after crystalloid administration in voluntary blood donors as a model for acute hemorrhage. STUDY DESIGN A prospective, randomized control trial was conducted in conjunction with community blood drives. Donors were randomized to receive no IV fluid (noIVF), 2 liters of normal saline (NS), or 2 liters lactated Ringer's (LR) after blood donation. Blood samples were taken before donation of 500 mL of blood, immediately after donation, and after IV fluid administration. Hemoglobin (Hgb) was measured at each time point. Hemoglobin measurements between time points were compared between groups using standard statistical tests and the Bonferroni correction for multiple comparisons. Statistical significance was set at p ≤ 0.0167. RESULTS Of 165 patients consented, 157 patients completed the study. Average pre-donation Hgb was 14.3 g/dL. There was no difference in the mean Hgb levels after blood donation between the 3 groups (p > 0.05). Compared with the control group, there was a significant drop in Hgb in the crystalloid infused groups from the post-donation level to post-resuscitation (13.2 vs 12.1 vs 12.2 g/dL, p < 0.0001). A formula was created to predict hemoglobin levels from a given estimated blood loss (EBL) and volume replacement (VR): Hemodilution Hgb = (mean pre-donation Hgb - hemorrhage Hgb drop - equilibration hemoglobin drop - resuscitation Hgb drop) = Mean pre-donation Hgb - [(EBL/TBV)*l] - [(EBL/TBV)*h] - [(VR/TBV)*r], l = 5.111g/dL = blood loss coefficient, h = 6.722 g/dL = equilibration coefficient, r = 2.617g/dL = resuscitation coefficient. CONCLUSIONS This study proves the concept of hemodilution and derived a mathematical relationship between blood loss and resuscitation. These data may help to estimate response of hemoglobin levels to blood loss and fluid resuscitation in clinical practice.
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Acute kidney injury: Antioxidants do not PRESERVE kidney function after contrast exposure.
Solomon, R
Nature reviews. Nephrology. 2018;(3):148-149
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Involvement of NR and PM-NR in NO biosynthesis in cucumber plants subjected to salt stress.
Reda, M, Golicka, A, Kabała, K, Janicka, M
Plant science : an international journal of experimental plant biology. 2018;:55-64
Abstract
Nitrate reductase (NR) mainly reduces nitrate to nitrite. However, in certain conditions it can reduce nitrite to NO. In plants, a plasma membrane-associated form of NR (PM-NR) is present. It produces NO2- for nitrite NO/reductase (Ni-NOR), which can release NO into the apoplastic space. The effect of 50 mM NaCl on NO formation and the involvement of NR in NO biosynthesis were studied in cucumber seedling roots under salt stress. In salt-stressed roots, the amount of NO was higher than in control. The application of tungstate abolished the increase of NO level in stressed roots, indicating that NR was responsible for NO biosynthesis under the test conditions. The involvement of other molybdoenzymes was excluded using specific inhibitors. Furthermore, higher cNR and PM-NR activities were observed in NaCl-treated roots. The increase in NR activity was due to the stimulation of CsNR genes expression and posttranslational modifications, such as enzyme dephosphorylation. This was confirmed by Western blot analysis. Moreover, the increase of nitrite tissue level in short-term stressed roots and the nitrite/nitrate ratio, with a simultaneous decrease of nitrite reductase (NiR) activity, in both short- and long-term stressed roots, could promote the production of NO by NR in roots under salt stress.