75 research outputs found
Metabolic profiling detects early effects of environmental and lifestyle exposure to cadmium in a human population
Background: The ‘exposome’ represents the accumulation of all environmental exposures across a lifetime. Topdown
strategies are required to assess something this comprehensive, and could transform our understanding of
how environmental factors affect human health. Metabolic profiling (metabonomics/metabolomics) defines an
individual’s metabolic phenotype, which is influenced by genotype, diet, lifestyle, health and xenobiotic exposure,
and could also reveal intermediate biomarkers for disease risk that reflect adaptive response to exposure. We
investigated changes in metabolism in volunteers living near a point source of environmental pollution: a closed
zinc smelter with associated elevated levels of environmental cadmium. Methods: High-resolution 1H NMR spectroscopy (metabonomics) was used to acquire urinary metabolic profiles
from 178 human volunteers. The spectral data were subjected to multivariate and univariate analysis to identify
metabolites that were correlated with lifestyle or biological factors. Urinary levels of 8-oxo-deoxyguanosine were
also measured, using mass spectrometry, as a marker of systemic oxidative stress. Results: Six urinary metabolites, either associated with mitochondrial metabolism (citrate, 3-hydroxyisovalerate, 4-
deoxy-erythronic acid) or one-carbon metabolism (dimethylglycine, creatinine, creatine), were associated with
cadmium exposure. In particular, citrate levels retained a significant correlation to urinary cadmium and smoking
status after controlling for age and sex. Oxidative stress (as determined by urinary 8-oxo-deoxyguanosine levels)
was elevated in individuals with high cadmium exposure, supporting the hypothesis that heavy metal
accumulation was causing mitochondrial dysfunction. Conclusions: This study shows evidence that an NMR-based metabolic profiling study in an uncontrolled human
population is capable of identifying intermediate biomarkers of response to toxicants at true environmental
concentrations, paving the way for exposome research.
Keywords: metabonomics, cadmium, environmental health, exposome, metabolomics, molecular epidemiolog
Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies
Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding
Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study
Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe
On the Winning Virtuous Strategies for Ultra High Frequency Electronic Trading in Foreign Currencies Exchange Markets
1153 A Dose-Response Efficacy and Safety Study of Arbaclofen Placarbil as Adjunctive Therapy in GERD Patients Who Incompletely Responded to PPI Therapy
Evaluating the Influence of CAM5 Aerosol Configuration on Simulated Tropical Cyclones in the North Atlantic
This study examines the influence of prescribed and prognostic aerosol model configurations on the formation of tropical cyclones (TCs) in the North Atlantic Ocean in Community Atmosphere Model version 5 (CAM5). The impact of aerosol parameterization is examined by investigating storm track density, genesis density, potential intensity, and genesis potential index. This work shows that both CAM5 configurations simulate reduced storm frequency when compared to observations and that differences in TC climatology between the model configurations can be explained by differences in the large-scale environment. The analysis shows that simulation with the prognostic aerosol parameterization scheme reasonably captures the observed interannual variability in tropical cyclones and aerosols (i.e., dust) in the North Atlantic, while simulation with the prescribed configuration (climatology) is less favorable. The correlation between dust and TCs in observations (i.e., reanalysis and satellite datasets) is shown to be negative, and this relationship was also found for the prognostic aerosol configuration despite an overall decrease in the frequency of TCs. This indicates that, to accurately replicate certain aspects of TC interannual variability, the aerosol configuration within CAM5 needs to account for the appropriate dust variability
W1105 Clinical Pharmacokinetics and Pharmacodynamics of Arbaclofen Placarbil, a Novel Reflux Inhibitor, in Subjects With GERD
Limiting or liberating? The influence of parliaments on military deployments in multinational settings
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