The purpose of this study was to assess the clinical usefulness of near-infrared spectroscopy (cerebral oximetry) in patients presenting to the emergency department (ED) with carbon monoxide (CO) intoxication. Eighteen patients with a diagnosis of CO intoxication who presented to our ED during 2013 were included in this prospective study. All patients were treated and monitored according to the standard recommendations for CO intoxication. In addition, cerebral oxygen saturation (ScO2) was measured using near-infrared spectroscopy, also known as cerebral oximetry. Minimum and maximum ScO2 values from the right and left frontal region were recorded using cerebral oximetry from immediately after presentation to the ED until discharge. Patient blood carboxyhemoglobin (COHb) levels before and after oxygen treatment were compared with the cerebral oximetry measurements. At the time of admission, mean blood (COHb) values were 29.3% ± 6.7%, and ScO2 values were 59.0 ± 4.0 in the right frontal region and 60.9 ± 5.1 in the left. When blood COHb levels had returned to normal following oxygen therapy, ScO2 values were 75.9 ± 6.1 (65.5–90.5) in the right frontal region and 74.9 ± 7.8 (62.0–90.0) in the left. The differences in ScO2 values before and after oxygen therapy were statistically significant (P ≤ 0.005). Assessment of patients exposed to CO gas using cerebral oximetry can provide information about cerebral oxygen saturation. Blood COHb level measurement is still the best method for diagnosing CO intoxication; however, cerebral oximetry, a non-invasive technique, may be an effective method for assessing cerebral oxygen saturation.
Tyrosine kinase inhibitors such as sorafenib and axitinib were developed to treat malignancies, including stage IV renal cell carcinoma. Recently, we experienced a patient with pancreatic side effects from both sorafenib and axitinib. We report this case and include a discussion of the literature.
Recent randomized trials and subsequent meta-analyses have questioned the value of n-3 fatty acid supplementation in cardiovascular disease risk reduction. This lecture will review the clinical trials published between 2010 and 2014 that failed to show benefits of n-3 fatty acids, and one meta-analysis from 2012 that used a controversial statistical approach to conclude no effect. The question of the extent to which n-3 fatty acid supplementation reduces risk for cardiovascular disease remains open. Future studies must be properly powered, use doses of n-3 fatty acids significantly higher than those provided in background diets, focus on patient populations with low n-3 fatty acid tissue levels, treat for longer periods of time, and consider the effects of these agents in the great majority of patients who are not on guideline-directed therapeutic regimens. The strong evidence-base from prospective cohort studies and the ever-deepening understanding of the cellular effects of long-chain n-3 fatty acids together support the need for these nutrients in reducing cardiovascular risk. Short-term findings from randomized controlled trials need to be interpreted in the light of all the evidence.(Presented at the 1907th Meeting, October 27, 2015)
All mammals harbor two types of adipose tissues that serve distinct physiological functions: white adipose tissue (WAT) and brown adipose tissue (BAT). WAT functions mainly in the storage of excess energy, while BAT specializes in dissipating energy in the form of heat and functions as a defense against hypothermia and obesity. Since adult humans possess significant amounts of active BAT depots and it’s mass inversely correlates with adiposity, BAT plays an important role in human obesity and energy homeostasis.New evidence suggests two types of thermogenic adipocytes with distinct developmental and anatomical features: classical brown adipocytes and beige adipocytes. Classical brown adipocytes are located mainly in dedicated BAT depots of rodents and infants. Beige adipocytes, on the other hand, reside mainly in subcutaneous WAT where they arise postnatally in response to certain external cues, such as chronic cold exposure and long-term treatment with PPAR- agonists, a process often referred to as the “browning” of WAT. Importantly, adult human BAT appears to be mainly composed of beige-like adipocytes, making this cell type an attractive therapeutic target for obesity and obesity-related diseases, such as insulin resistance and type2 diabetes. I will review recent progress in the molecular control of brown and beige adipocyte development and discuss emerging questions.(Presented at the 1912th Meeting, December 21, 2015)