Treatment of acute hypernatremia caused by sodium overload in adults: A systematic review

Background:Rapid-onset, acute hypernatremia caused by sodium overload is a rare, life-threatening condition. Although experts recommend rapid correction of sodium concentration [Na] based on pathophysiological theories, only a few reports have documented the specific details of sodium correction methods. The objective of this study was to systematically review the reported treatment regimens, achieved [Na] correction rates, and treatment outcomes.Methods:PubMed, Ichushi-database, and references without language restrictions, from inception to January 2021, were searched for studies that described ≥1 adult (aged ≥18 years) patients with rapid-onset hypernatremia caused by sodium overload, whose treatment was initiated ≤12 hours from the onset. The primary outcome of interest was the [Na] correction rate associated with mortality.Results:Eighteen case reports (18 patients; median [Na], 180.5 mEq/L) were included. The cause of sodium overload was self-ingestion in 8 patients and iatrogenic sodium gain in 10 patients; baseline [Na] and symptoms at presentation were comparable for both groups. Individualized rapid infusion of dextrose-based solutions was the most commonly adopted fluid therapy, whereas hemodialysis was also used for patients already treated with hemodialysis. The correction rates were more rapid in 13 successfully treated patients than in 5 fatal patients. The successfully treated patients typically achieved [Na] ≤160 within 8 hours, [Na] ≤150 within 24 hours, and [Na] ≤145 within 48 hours. Hyperglycemia was a commonly observed treatment-related adverse event.Conclusion:The limited empirical evidence derived from case reports appears to endorse the recommended, rapid, and aggressive sodium correction using dextrose-based hypotonic solutions.     

Association of hla-b39 with hla-b27-negative ankylosing spondylitis and pauciarticular juvenile rheumatoid arthritis in japanese patients

Objective. To investigate the characteristics of HLA-B27 that render susceptibility to seronegative spondylarthropathies. Methods. Serologic HLA class I typing of Japanese patients with ankylosing spondylitis (AS), juvenile rheumatoid arthritis (JRA), and healthy controls, was performed. HLA-B39 subtypes were determined by polymerase chain reaction-sequence-specific oligohy-bridization. Results. HLA-B27 was present in 40 of 48 patients with AS (83%), and in only 1 of 210 healthy controls (0.5%). Three of 8 patients (37.5%) who were negative for HLA-B27 were positive for HLA-B39, which was significantly higher compared with the HLA-B27-negative controls (6.2% P = 0.01). Significant association with HLA-B39 was also noted in the JRA patients (16.7%; P < 0.01), especially in those patients with pauciarticular-onset disease (33.3%; P < 0.01). Ten of 13 HLA-B39-positive patients had subtype B^*3901 and 3 had B^*3902. Conclusion. Because HLA-B27 and HLA-B39 share Glu at position 45 and Cys at position 67, both of which constitute components of the peptide-anchoring B pocket, and because they possess similar peptide-ligand motifs, our results may support either the role of the peptides presented by class I antigens or the importance of Cys at position 67, in the development of spondylarthropathies and pauciarticular-onset JRA.     

The normative score and the cut-off value of the Oswestry Disability Index (ODI)

Purpose

The Oswestry Disability Index (ODI) is one of the most common scoring systems used for patients with low back pain (LBP). Although the normative score of the ODI was reported to be 10.19 in a review article, no study has calculated the normative score after adjusting the value based on the age distribution. In addition, none of the previous studies has estimated the cut-off value which separates LBP with disability from LBP without disability. The purpose of this study was to estimate the normative score by adjusting the data for age distribution in Japan, and to determine the cut-off value which separates LBP with disability from LBP without disability.

Methods

We conducted an internet survey on LBP using the Japanese version of the ODQ. A total of 1,200 respondents, composed of 100 males and 100 females in each age group (from the 20s to 70s), participated in this study. We also asked them to provide information about their backgrounds. We estimated the normative score after correcting for the age distribution of Japan. We also estimated the ODI of those with or without disability, the factors associated with the ODI, and the cut-off value which separates LBP with disability from LBP without disability.

Results

The participants’ backgrounds were similar to the national survey. The normative score of the ODI was estimated at 8.73. The ODI of the LBP with disability group was 22.07. Those with sciatica and obese subjects showed higher ODI than those without. The optimal cut-off value was estimated to be 12.

Conclusions

We defined the normative score and the cut-off value of the ODI.     

Optimizing quantitative in vivo fluorescence imaging with near‐infrared quantum dots

Quantum dots (QDs) are fluorescent nanoparticles with broad excitation and narrow, wavelength‐tunable emission spectra. They are used extensively for in vitro fluorescence imaging studies and more recently for in vivo small animal and pre‐clinical studies. To date there has been little concern about the selection of QD size (and thus emission wavelength peak) and excitation wavelengths, as they have little relevance to the results of in vitro studies. In vivo imaging, however, poses additional constraints, such as the scattering and absorption by tissue, which may influence the signal intensity at the body surface. Here, we demonstrate that longer‐wavelength excitation and emission yield less quantization error in measured relative fluorescence intensity, using three near‐infrared QDs (QD655, QD705 and QD800) applied to in vivo lymphatic imaging, and a range of excitation wavelengths from the blue to the red. Statistically significant differences in quantization error were observed between nearly all pairs of excitation wavelengths (445–490, 503–555, 575–605, 615–665 and 671–705 nm). Similarly, quantization error decreased with longer emission wavelengths (655, 705 and 800 nm). Light absorbance and scattering were demonstrated to be more potent factors than absorbance efficiency of QDs in producing quantization error in the measured fluorescence intensity. As a result, while wavelengths can be adjusted for qualitative experiments, the longest possible wavelengths should be used if quantification is desired during QD imaging experiments. Copyright © 2010 John Wiley & Sons, Ltd.     

The relationships among filling,voiding subscores from International Prostate Symptom Score and quality of life in Japanese elderly men and women

OBJECTIVES: Lower urinary tract symptoms (LUTS) are reported to influence the quality of life (QoL) of the elderly. The aim of this study was to elucidate the relationships among filling problems, voiding problems and QoL in elderly men and women. METHODS: A total of 450 males and 228 females, aged 50 years or older responded to a questionnaire, which included seven questions from the International Prostate Symptom Score (I-PSS) and 16 questions from the King's Health Questionnaire (KHQ). The relations among the filling, voiding subscores deliverable from I-PSS, and KHQ-QoL were investigated. RESULTS: The voiding subscore significantly correlated with the filling subscore with a considerably large standard deviation, and the filling subscore also significantly correlated with I-PSS in both genders. KHQ-QoL was significantly associated with the filling and voiding subscores in almost all domains of the KHQ. Multiple regression analyses demonstrated the filling, voiding subscores, and I-PSS explained the 55% or greater reduction in the QoL in six, four, six domains in men and four, three, four domains in women, respectively. CONCLUSIONS: The filling problems are slightly more associated with KHQ-QoL than voiding problems but filling problems did not appear to predominantly affect QoL as expected in both genders. We believe it valid to use I-PSS to evaluate voiding problems as well as filling problems in the elderly women.