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Background: Carbon monoxide (CO) poisoning is a major health problem associated with a high rate of severe morbidity and mortality. Aims: This study aimed to evaluate the validity of the serum glucose/potassium (Glu/K) ratio as a quick predictor of both early and delayed unfavorable outcomes following acute CO poisoning. Patients and methods: This prospective cohort study included 136 patients with acute CO poisoning admitted at Tanta Poison Control Center, Egypt, between January 2023 and June 2024. The serum Glu/K ratio was calculated for all patients. The primary outcome was a prediction of mortality. Secondary outcomes were the prediction of delayed neurological sequelae (DNS) within six months after CO exposure, the need for mechanical ventilation, and the need for hyperbaric oxygen. A receiver operating curve analysis was applied to test the performance of the Glu/K ratio in predicting acute CO poisoning outcomes. Results: The mortality rate was 12.5% of patients with acute CO poisoning. Meanwhile, 14.7% of patients developed DNS. Furthermore, mechanical ventilation was required in 16.9% of patients. An elevated Glu/K ratio was significantly associated with the severity of acute CO poisoning. At a cut-off value of >31.62, the Glu/K ratio demonstrated an AUC of 0.649 for predicting mortality. The Glu/K ratio was employed to predict DNS at a cut-off value of 33.10, with a sensitivity of 60.0%, a specificity of 82.76%, and an AUC of 0.692. Conclusions: Early Glu/K ratio may be an effective, reliable, and convenient laboratory predictor of mortality, DNS, and the need for mechanical ventilation in patients with acute CO poisoning. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effects of contamination of venous blood with a lipid-containing solution on parameters measured by a modern blood gas analyzer. We collected venous blood from 17 healthcare workers (46 ± 11 years; 53 % women) into three blood gas syringes containing 0 , 5 and 10 % lipid-containing solution. Blood gas analysis was performed within 15 min from sample collection on GEM Premier 5000, while triglycerides and serum indices were assays on Roche COBAS C702. Triglycerides concentration increased from 1.0 ± 0.3 mmol/L in the uncontaminated blood gas syringe, to 39.4 ± 7.8 and 65.3 ± 14.4 mmol/L (both p<0.001) in syringes with 5 and 10 % final lipid contamination. The lipemic and hemolysis indices increased accordingly. Statistically significant variation was noted for all analytes except hematocrit and COHb in the syringe with 5 % lipids, while only COHb did not vary in the syringe with 10 % lipids. Significant increases were observed from 5 % lipid contamination for pO2, SO2 and lactate, while the values of pH, pCO2, sodium, potassium, chloride, ionized calcium, glucose, hematocrit (10 % contamination), hemoglobin and MetHB decreased. All these changes except lactate and CoHb exceeded their relative performance specifications. Artifactual hyperlipidemia caused by contamination with exogenous lipids can have a clinically significant impact on blood gas analysis. Manufacturers of blood gas analyzers must be persuaded to develop new instruments equipped with serum indices. [ABSTRACT FROM AUTHOR]

Aim: Hookah smoking is increasing all over the world, and it can cause many health problems that are rarely known to be experienced by smokers. The aim of this study was to evaluate the acute impact of hookah smoking on hemodynamic parameters using perfusion index (PI) and pleth variability index (PVI). Materials and Methods: This prospective observational study was conducted in a hookah cafe with 84 participants. Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse, oxygen saturation (SpO2), carboxyhemoglobin (COHb) PI, and PVI values of the participants were measured immediately before and 30 min after hookah smoking. Results: Sixty-three (75%) participants were male, and the median age was 26 [interquartile range (IQR) 22-29]. There were no significant changes in SBP, DBP, pulse, and SpO2 following hookah smoking. There was a 2% (IQR 2-3) increase in COHb level (p

Jiwoong Her,1,2 Justin Roh,1 Deborah A Keys3 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA; 2Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA; 3Kaleidoscope Statistics, LLC Athens, GA, USACorrespondence: Jiwoong Her, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA, Email Jiwoong.her@outlook.comPurpose: To assess the agreement between pulse co-oximeter and blood co-oximeter in measuring methemoglobin (MetHb) and carboxyhemoglobin (COHb) in healthy, awake dogs.Patients and Methods: Forty-five healthy dogs were enrolled in the study. Pulse co-oximetry was performed using the Masimo Radical 7 Pulse Co-Oximeter with a Rainbow® adhesive sensor. Simultaneously, venous blood samples were collected, and MetHb and COHb were immediately measured using a Stat Profile Prime Plus VET Critical Care Analyzer. Paired measurements of MetHb and COHb were evaluated via Spearman correlation, intra-class correlation (ICC), and Bland-Altman plots to evaluate the degree of agreement between the pulse co-oximeter and the blood co-oximeter.Results: A total of 45 paired MetHb and COHb measurements were collected. There was a weak correlation between the pulse co-oximeter and the blood co-oximeter readings. The correlation coefficients for MetHb and COHb were 0.0 (95% CI, − 0.3 to 0.3) and 0.03 (95% CI, − 0.27 to 0.32), respectively. The ICC indicated poor agreement between the pulse and blood co-oximeter for MetHb (ICC = 0.00, 95% CI: − 0.12 to 0.15) and COHb (ICC = 0.03, 95% CI: − 0.27 to 0.33). Bland-Altman plots revealed low mean bias but wide limits of agreement, indicating that the pulse co-oximeter overestimated MetHb by on average of 0.7% (P < 0.0001) (95% LoA: − 0.5 to 2.0) and COHb by on average 0.2% (P = 0.59) (95% LoA: − 4.6 to 5.0).Conclusion: Obtaining MetHb and COHb measurements with the Masimo Radical 7 Pulse Co-Oximeter is straightforward in healthy, awake dogs. However, the device does not provide accurate measurements compared to the blood co-oximeter, specifically in the range of MetHb and COHb in healthy dogs, based on the wide LoA.Keywords: co-oximetry, methemoglobin, carboxyhemoglobin, dog

Objective: Electrocautery in laparoscopic surgeries converts abdominal carbon dioxide gas into carbon monoxide, which binds to hemoglobin with a higher affinity than oxygen and can impair oxygen transport and lead to hypoxia. This study aimed to assess changes in carboxyhemoglobin (COHb) levels and investigate the factors affecting COHb levels in patients undergoing robotic surgery. Methods: Forty-two patients were included in this retrospective study. Patient demographics, anesthetic used, airway pressures, and COHb levels at different time points (baseline COHb-1st hour COHb-post-pneumoperitoneum COHb-postoperative care unit COHb-deltaCOHb) were considered. Age, gender, American Society of Anesthesiology (ASA) physical score, body mass index, smoking status, surgery type, anesthesia type, patient position, fresh gas flow (FGF), insufflation, and airway pressures, which may have an effect on COHb levels, were compared. Results: No significant relationship was found between COHb levels at all measured time points and factors such as gender, ASA scores, surgery type, anesthesia type, position, FGF, insufflation pressure, and airway pressure. Smokers had significantly higher COHb levels than passive smokers, non-smokers, and ex-smokers at baseline (p=0.003), 1st hour (p=0.006), and post-pneumoperitoneum COHb (p=0.009) levels. Conclusion: Long surgery time, use of different types of anesthetics, and low FGF does not increase the risk of elevated COHb levels. Hence, different anesthetic drugs and low FGF, regardless of the position of the patient or the length of the procedure, can be used in robotic surgery without increasing the risk. [ABSTRACT FROM AUTHOR]

This article, titled "Carbon Monoxide: An Ancient Silent Enemy," provides a historical and contemporary perspective on the impact of carbon monoxide (CO) on humans. It discusses various incidents throughout history where CO poisoning occurred, including the deaths of crew members on Arctic expeditions and the dangers of coal gas in the 19th century. The article also explores the toxic effects of CO on the body and the symptoms of chronic CO poisoning. It concludes by emphasizing the ongoing threat of CO poisoning and the importance of detection and prevention. [Extracted from the article]

We use air pollution exposure measurements and household survey data from four studies conducted across three countries in sub‐Saharan Africa (SSA) to analyze the association between carbon monoxide (CO) exposure from cooking with biomass and indicators of cognitive impairment. While there is strong evidence on the relationship between ambient air pollution exposure and cognitive impairment from studies in high‐income countries, relatively little research has focused on household air pollution (HAP) in low‐income country settings where risks of HAP exposure are high. This study is the first to our knowledge to focus on the association between HAP exposure (specifically CO exposure) and cognitive impairment across diverse settings in SSA. We use 24‐hour measurements of primary cooks' exposure to CO across four study sites: urban Zambia (n = 493); urban Malawi (n = 130); rural Malawi (n = 102); and urban Rwanda (n = 2,576). We model the estimated percent carboxyhemoglobin (%COHb) of cooks and map values to a toxicological profile for risk of cognitive impairment. We find that across all study settings, cooks' average %COHb levels are below levels of daily concern, but that cooks who use charcoal for preparing greater than 40% of meals are more likely to spend additional time at higher levels of risk. For the urban Zambia sample, we compare %COHb and frequency of charcoal use to a series of cognitive test scores and find no consistent relationships between %COHb and cognitive test scores. High levels of daily CO exposure from cooks across SSA highlight the potential for longer‐term negative cognitive (and other) health outcomes motivating additional research and efforts to characterize and mitigate risk. [ABSTRACT FROM AUTHOR]

INTRODUCTION In this study, we investigate the effects of smoking on pain scores, vital signs, and analgesic consumption in the intraoperative and postoperative period in patients undergoing tympanomastoidectomy surgery. METHODS A total of 100 patients with American Society of Anesthesiologists I-II status, aged 18-55 years, and who were planned to undergo tympanomastoidectomy surgery were divided into two groups: smokers (Group 1) and non-smokers (Group 2). The patients were compared for preoperative, intraoperative, and 24-hour postoperative carboxyhemoglobin, blood pressure, oxygen saturation, respiratory rate, heart rate, pain intensity and verbal numerical rating scales, the extent of patient-controlled tramadol dose, nausea, and vomiting. RESULTS There were 50 individuals in each group. Postoperative analgesic consumption and pain scores were higher in Group 1, and the first postoperative pain was felt earlier. Furthermore, in Group 1, preoperative carboxyhemoglobin levels and postoperative nausea were statistically higher before, after, and at the tenth minute after induction, whereas oxygen saturation was lower. The two groups had no statistical difference regarding intraoperative and postoperative vital signs. Postoperative analgesic consumption was not affected by age or gender. CONCLUSIONS Smoking changes postoperative pain management, especially for this kind of operation, and these patients feel more pain and need more postoperative analgesic doses. Therefore, effective postoperative pain control should take account of smoking behavior, and analgesic doses may need to be adjusted for patients who smoke. [ABSTRACT FROM AUTHOR]

Carbon monoxide poisoning is one of the leading causes of mortality and morbidity by poisoning in the world. Signs and symptoms are nonspecific and related to impaired oxygen delivery to tissues, with the brain being the most affected organ due to its high oxygen demand. CO-Hb is a poor indicator of severity and long-term outcome, with clinicians relying more on clinical features such as level of consciousness and need for intubation, organ dysfunction and shock and also pH level. A 45-year-old female was found unconscious in her home with the fireplace lit and smoke all over the house. She was last seen well 18 hours before. She was brought to the emergency department and was admitted to the ICU in coma and cardiogenic shock, with a metabolic acidosis with hyperlactacidemia and a CO-Hb level of 15.5%. Laboratorial investigation revealed hepatic cytolysis, acute renal failure, rhabdomyolysis and a troponin I level of 338 ng/L. ECG showed no acute myocardial ischemia. Echocardiogram revealed diffuse hypokinesia with an ejection fraction of 25%. Head CT scan showed bilateral and symmetrical hypodensities of the globus pallidus. The patient underwent hyperbaric oxygen treatment with full neurological and cardiac recovery, allowing extubation 48 hours after admission. This rare severe case of coma due to carbon monoxide intoxication with globus pallidus injury and cardiogenic shock was successfully treated with hyperbaric oxygen, showing that it can be the right treatment choice in these cases, with an excellent impact on neurological and cardiac outcome. [ABSTRACT FROM AUTHOR]

Fire-related deaths are usually a consequence of carbon monoxide (CO) poisoning or shock from thermal injuries. In humans, high levels of carboxyhemoglobin (COHb) concentrations in the blood can support a diagnosis of CO poisoning. In veterinary medicine, few studies investigated the pathological changes and blood COHb% in fire victims, and no data are available on post-mortem changes in blood gas composition due to fire. This study aims to investigate the pathological changes and COHb levels in both animal victims of fire and cadavers experimentally exposed to fire. For this purpose, dogs were selected and subdivided into three groups. Group A comprised 9 adult dogs, and Group B comprised 7 puppies that died under fire-related conditions. Group C was represented by 4 dog cadavers experimentally exposed to heat and smoke. A complete macroscopic, histological, and COHb evaluation were performed on each animal. Animals in Groups A and B showed cherry-red discoloration, thermal-injuries and soot deposits along the respiratory tract. Animals in Group C showed thermal injuries and soot deposits limited to the upper respiratory tract. The mean COHb% values in cadavers in Group C were lower than those observed in the other groups but higher compared to the values detected before the heat and smoke treatment. These findings suggest that both pathological changes and COHb analysis are valid tools for investigating fire-related deaths in dogs. However, the increase of COHb levels in cadavers exposed postmortem to heat and smoke highlights how the COHb analysis should always be evaluated together with macroscopical and microscopical findings to avoid significant misjudgments in investigating fire-related fatalities in veterinary forensic practice. [ABSTRACT FROM AUTHOR]

In today’s world, where stress and busyness are an integral part of everyday life, energy drinks have become not only a means of satisfying the need for energy and maintenance of vitality, but also a symbol of lifestyle, an important element of the modern culture of consumption. The speed and efficiency they promise attract the attention of consumers, especially those who are constantly on the move. Such drinks have become popular not only among young people, but also among everyone who seek to maintain their activity and efficiency during the day. The purpose of the work was to investigate the dynamics of changes in the level of total hemoglobin and its forms, in particular oxy-, carboxy-, sulf-, met-, and dyshemoglobin under the conditions of energy drink consumption. The study was conducted using male Wistar rats weighing 150–220 g kept in the vivarium under appropriate lighting conditions, temperature, humidity and standard diet. All the animals had free access to feed (based on daily requirements) and water (based on 20 ml of water per rat per day). The experiment was carried out in compliance with the requirements of the European Convention for the Protection of Vertebrate Animals used for Experimental and Scientific Purposes (Strasbourg, 1986). The animals were divided into five groups: the 1st group received drinking water (intact control); the 2nd–5th groups received daily the non-alcoholic energy drink “Burn” per os for a month. The calculation of the required amount of drink for administration per one rat was based per 1 kg of body weight. To monitor the growth and development, we weighted the rats at the beginning and at each stage of the experiment. The material (blood) was taken on the 1st (2nd group), 10th (3rd group), 20th (4th group) and 30th day (5th group) after the completion of the experiment under anesthesia (intramuscularly sodium thiopental, 60 mg/kg). The total hemoglobin level was determined with the Mythic 18 hematological analyzer. Determination of the content of oxyhemoglobin, methemoglobin, sulfhemoglobin and carboxyhemoglobin was performed spectrophotometrically. The obtained data indicate significant changes in both the total level of hemoglobin and its ligand forms, in particular, a decrease in the level of oxyhemoglobin and the accumulation of dyshemoglobins, such as methemoglobin, sulfhemoglobin, and carboxyhemoglobin. As evidenced by the obtained results, the consumption of energy drinks leads to the oxygen homeostasis violation, the development of tissue hypoxia and can cause structural and functional disorders in the body under such conditions.

While mounting evidence suggests that wildland fire smoke (WFS) inhalation may increase the burden of cardiopulmonary disease, the occupational risk of repeated exposure during wildland firefighting remains unknown. To address this concern, we evaluated the cardiopulmonary function in mice following a cumulative exposure to lab-scale WFS equivalent to a mid-length wildland firefighter (WLFF) career. Dosimetry analysis indicated that 80 exposure hours at a particulate concentration of 22 mg/m3 yield in mice the same cumulative deposited mass per unit of lung surface area as 3600 h of wildland firefighting. To satisfy this condition, male Apoe-/- mice were whole-body exposed to either air or smoldering Douglas fir smoke (DFS) for 2 h/day, 5 days/week, over 8 consecutive weeks. Particulate size in DFS fell within the respirable range for both mice and humans, with a count median diameter of 110 ± 20 nm. Expiratory breath hold in mice exposed to DFS significantly reduced their minute volume (DFS: 27 ± 4; Air: 122 ± 8 mL/min). By the end of the exposure time frame, mice in the DFS group exhibited a thicker (DFS: 109 ± 3; Air: 98 ± 3 μm) and less distensible (DFS: 23 ± 1; Air: 28 ± 1 MPa-1) aorta with reduced diastolic blood augmentation capacity (DFS: 53 ± 2; Air: 63 ± 2 kPa). Cardiac magnetic resonance imaging further revealed larger end-systolic volume (DFS: 14.6 ± 1.1; Air: 9.9 ± 0.9 μL) and reduced ejection-fraction (DFS: 64.7 ± 1.0; Air: 75.3 ± 0.9 %) in mice exposed to DFS. Consistent with increased airway epithelium thickness (DFS: 10.4 ± 0.8; Air: 7.6 ± 0.3 μm), airway Newtonian resistance was larger following DFS exposure (DFS: 0.23 ± 0.03; Air: 0.20 ± 0.03 cmH2O-s/mL). Furthermore, parenchyma mean linear intercept (DFS: 36.3 ± 0.8; Air: 33.3 ± 0.8 μm) and tissue thickness (DFS: 10.1 ± 0.5; Air: 7.4 ± 0.7 μm) were larger in DFS mice. Collectively, mice exposed to DFS manifested early signs of cardiopulmonary dysfunction aligned with self-reported events in mid-career WLFFs.

Background: The continuous exposure of blood to a non-biological surface during extracorporeal membrane oxygenation (ECMO) may lead to progressive thrombus formation in the oxygenator, hemolysis and consequently impaired gas exchange. In most centers oxygenator performance is monitored only on a once daily basis. Carboxyhemoglobin (COHb) is generated upon red cell lysis and is routinely measured with any co-oximetry performed to surveille gas exchange and acid–base homeostasis every couple of hours. This retrospective cohort study aims to evaluate COHb in the arterial blood gas as a novel marker of oxygenator dysfunction and its predictive value for imminent oxygenator change. Results: Out of the 484 screened patients on ECMO 89, cumulatively requiring 116 oxygenator changes within 1833 patient days, including 19,692 arterial COHb measurements were analyzed. Higher COHb levels were associated with lower post-oxygenator pO2 (estimate for log(COHb): − 2.176 [95% CI − 2.927, − 1.427], p < 0.0001) and with a shorter time to oxygenator change (estimate for log(COHb): − 67.895 [95% CI − 74.209, − 61.542] hours, p < 0.0001). COHb was predictive of oxygenator change within 6 h (estimate for log(COHb): 5.027 [95% CI 1.670, 15.126], p = 0.004). Conclusion: COHb correlates with oxygenator performance and can be predictive of imminent oxygenator change. Therefore, longitudinal measurements of COHb in clinical routine might be a cheap and more granular candidate for ECMO surveillance that should be further analyzed in a controlled prospective trial design. [ABSTRACT FROM AUTHOR]

CO2 anesthesia is the most common method for immobilizing Drosophila for research purposes. But CO2 exposure has consequences—it can impact fertility, behavior, morphogenesis, and cytoskeletal dynamics. In this respect, Drosophila is an outstanding model for studying the impact of CO2 exposure on tissues. In this study we explored the response of intracellular pH (pHi) to a one-minute CO2 pulse using a genetically encoded, ubiquitously expressed pH sensor, tpHusion, to monitor pHi within a live, intact, whole fly. We compared wild-type flies to flies lacking Imaginal disc growth factors (Idgfs), which are chitinase-like proteins that facilitate developmental processes and the innate immune response. Morphogenetic and cytoskeletal defects in Idgf-null flies are enhanced after CO2 exposure. We found that pHi drops sharply within seconds of the beginning of a CO2 pulse and recovers over several minutes. The initial profile was nearly identical in control and Idgf-null flies but diverged as the pHi returned to normal. This study demonstrates the feasibility of monitoring pH in live adult Drosophila. Studies exploring pH homeostasis are important for understanding human pathologies associated with pH dysregulation. [ABSTRACT FROM AUTHOR]

Oxidative stress represents a hallmark for many degenerative pathologies of the Central Nervous System. Throughout life, the constant pressure of noxious stimuli and/or episodes of traumatic events may expose the brain to a microenvironment where the non-balanced reactive oxygen species inevitably lead to neuronal loss and cognitive decline. HO-1, a 32 kDa heat-shock protein catalyzing the degradation of heme into carbon monoxide (CO), iron and biliverdin/bilirubin is considered one of the main antioxidant defense mechanisms playing pivotal roles in neuroprotection. Restoring the redox homeostasis is the goal of many natural or synthetic antioxidant molecules pursuing beneficial effects on brain functions. Here, we investigated the antioxidant capacity of four selected benzofuran-2-one derivatives in a cellular model of neurodegeneration represented by differentiated SH-SY5Y cells exposed to catechol-induced oxidative stress. Our main results highlight how all the molecules have antioxidant properties, especially compound 9, showing great abilities in reducing intracellular ROS levels and protecting differentiated SH-SY5Y cells from catechol-induced death. This compound above all seems to boost HO-1 mRNA and perinuclear HO-1 protein isoform expression when cells are exposed to the oxidative insult. Our findings open the way to consider benzofuran-2-ones as a novel and promising adjuvant antioxidant strategy for many neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

Carbon monoxide can cause severe harm to humans even at low concentrations. Metal Oxide Semiconductor (MOS) carbon monoxide gas sensors have excellent sensing performance regarding sensitivity, selectivity, response speed, and stability, making them very desirable candidates for carbon monoxide monitoring. However, MOS gas sensors generally work at temperatures higher than room temperature, and need a heating source that causes high power consumption. High power consumption is a great problem for long-term portable monitoring devices for point-of-care or wireless sensor nodes for IoT application. Room-temperature MOS carbon monoxide gas sensors can function well without a heater, making them rather suitable for IoT or portable applications. This review first introduces the primary working mechanism of MOS carbon monoxide sensors and then gives a detailed introduction to and analysis of room-temperature MOS carbon monoxide sensing materials, such as ZnO, SnO2, and TiO2. Lastly, several mechanisms for room-temperature carbon monoxide sensors based on MOSs are discussed. The review will be interesting to engineers and researchers working on MOS gas sensors. [ABSTRACT FROM AUTHOR]

The enzyme heme oxygenase-1 (HO-1) is pivotal in reproductive processes, particularly in placental and vascular development. This study investigated the role of HO-1 and its byproduct, carbon monoxide (CO), in trophoblastic spheroid implantation. In order to deepen our understanding of the role of HO-1 during implantation, we conducted in vivo experiments on virgin and pregnant mice, aiming to unravel the cellular and molecular mechanisms. Using siRNA, HO-1 was knocked down in JEG-3 and BeWo cells and trophoblastic spheroids were generated with or without CO treatment. Adhesion assays were performed after transferring the spheroids to RL-95 endometrial epithelial cell layers. Additionally, angiogenesis, stress, and toxicity RT2-Profiler™ PCR SuperArray and PCR analyses were performed in uterine murine samples. HO-1 knockdown by siRNA impeded implantation in the 3D culture model, but this effect could be reversed by CO. Uteruses from virgin Hmox1−/− females exhibited altered expression of angiogenesis and stress markers. Furthermore, there was a distinct expression pattern of cytokines and chemokines in uteruses from gestation day 14 in Hmox1−/− females compared to Hmox1+/+ females. This study strongly supports the essential role of HO-1 during implantation. Moreover, CO appears to have the potential to compensate for the lack of HO-1 during the spheroid attachment process. The absence of HO-1 results in dysregulation of angiogenesis and stress-related genes in the uterus, possibly contributing to implantation failure. [ABSTRACT FROM AUTHOR]

Some studies have shown the effect of air pollution on migraine. However, it needs to be confirmed in larger-scale studies, as scientific evidence is scarce regarding the association between air pollution and migraine. Therefore, this systematic review aims to determine whether there are associations between outdoor air pollution and migraine. A literature search was performed in Scopus, Medline (via PubMed), EMBASE, and Web of Science. A manual search for resources and related references was also conducted to complete the search. All observational studies investigating the association between ambient air pollution and migraine, with inclusion criteria, were entered into the review. Fourteen out of 1417 identified articles met the inclusion criteria and entered the study. Among the gaseous air pollutants, there was a correlation between exposure to nitrogen dioxide (NO2) (78.3% of detrimental relationships) and carbon monoxide (CO) (68.0% of detrimental relationships) and migraine, but no apparent correlation has been found for sulfur dioxide (SO2) (21.2% of detrimental relationships) and ozone (O3) (55.2% of detrimental relationships). In the case of particulate air pollutants, particulate matter with a diameter of 10 μm or less (PM10) (76.0% of detrimental relationships) and particulate matter with a diameter of 2.5 μm or less (PM2.5) (61.3% of detrimental relationships) had relationships with migraine. In conclusion, exposure to NO2, CO, PM10, and PM2.5 is associated with migraine headaches, while no conclusive evidence was found to confirm the correlation between O3 and SO2 with migraine. Further studies with precise methodology are recommended in different cities around the world for all pollutants with an emphasis on O3 and SO2. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To identify and characterize the population of Pediatric patients referred to our hyperbaric oxygen therapy center. Methods: Retrospective and observational study, including pediatric patients treated with hyperbaric oxygen therapy, from 2006 to 2021, at the hyperbaric medicine reference center in the north of Portugal. Variables of interest were extracted from electronic medical records. Results: Our study included 134 patients. The most frequent reasons for referral were carbon monoxide poisoning (n=59) and sudden sensorineural hearing loss (n=41). In 75 cases (56%), treatment was initiated in an urgent context. Symptom presentation at Emergency Department varied among patients, the most frequent being headache and nausea/vomiting. Concerning carbon monoxide poisoning, the most common sources were water heater, fireplace/brazier, and boiler. Regarding adverse effects, it was identified one case of intoxication by oxygen and four cases of middle ear barotrauma. Conclusions: The most frequent cause for referral was carbon monoxide poisoning. All patients evolved favorably, with few side effects being reported, emphasizing the safety of this therapy. While most pediatricians may not be aware of the potential benefits arising with hyperbaric oxygen therapy, it is of upmost importance to promote them, so that this technique is increasingly implemented.

The main method for estimating the level of arterial blood oxygenation is pulse oximetry, which has the advantages of being fast, simple, reliable, and non-invasive. However, in well-known pulse oximeters, oxygen saturation is determined only by hemoglobin functional fractions, which reduces the device accuracy and is unacceptable in certain clinical cases. The known pulse oximeter improvement that considers the dysfunctional fraction concentration, especially carboxyhemoglobin, when measuring the level of blood oxygenation is an actual scientific and technical task. The research subjects. Mathematical, algorithmic, and technical support of a pulse oximeter that measures blood oxygenation levels considering the carboxyhemoglobin concentration. Objective. To expand the pulse oximeter functionality to consider the concentration of carboxyhemoglobin in arterial blood. Methods. Methods of computer simulation for developing a model and estimating the pulse oximeter accuracy that measures the blood oxygenation level considering the carboxyhemoglobin concentration. Results. The theoretical statements of measuring the level of blood oxygenation considering the carboxyhemoglobin concentration and the simplest pulse oximeter structural diagram for measuring are developed. An additional LED used in the pulse oximeter is proposed, and the wavelength choice is justified on the condition of maximizing the carboxyhemoglobin contribution to the optical density of the biological object. Computer models of a traditional pulse oximeter and a pulse oximeter with an additional LED were developed, simulation research was conducted using the developed models, and the device accuracy for measuring the level of blood oxygenation was estimated considering the carboxyhemoglobin concentration. Conclusions. Simulation studies based on the developed models show that the proposed pulse oximeter, compared with the known one, allows determining and estimating a decrease in blood oxygenation caused by the carboxyhemoglobin concentration increasing in the patient’s blood. Considering that light is also absorbed by the third derivative of hemoglobin, carboxyhemoglobin, increases the accuracy of the proposed pulse oximeter in measuring functional saturation.

Objective: Carbon monoxide (CO) poisoning is a condition which oxygen transport is reduced and presentation is impaired. Red cell distribution width (RDW) is associated with many diseases. Although there are many studies on RDW in the literature, there are very few studies evaluating the relationship between CO poisoning and RDW. The aim of our study is to investigate whether relationship between CO poisoning and RDW. Methods: Patients who applied to the emergency service, CO poisoning was diagnosed, their age 18 years and over, their blood gas measurements showed a carboxyhemoglobin (COHb) level of ≥5%, were taken in this retrospective study. It was recorded that research participants' age, sex, COHb levels in blood gases, hemogram, consultation due to CO poisoning and effects, whether taken hyperbaric oxygen (HBO) and its outcomes. Whether there was a change that could be attributed to CO poisoning at the RDW levels was investigated. Results: Fifty-nine cases were included in the study. The mean RDW of the study group (13.61+-1.12) was higher than that of the control group (12.99+-0.59) (p

We conducted ab initio valence bond (VB) calculations employing the valence bond self-consistent field (VBSCF) and breathing orbital valence bond (BOVB) methods to investigate the nature of the coordination bonding between ferrous heme and carbon monoxide (CO) within cytochrome P450. These calculations revealed the significant influence exerted by both proximal and equatorial ligands on the π-backdonation effect from the heme to the CO. Moreover, our VB calculations unveiled a phenomenon of synergistic charge transfer (sCT). In the case of ferrous heme–CO bonding, the significant stabilization in this sCT arises from cooperative resonance between the VB structures associated with σ donation and π backdonation. Unlike many other ligands, CO possesses the unique ability to establish two mutually perpendicular π-backdonation orbital interaction pairs, leading to an intensified stabilization attributed to σ–π resonance. Furthermore, while of a smaller energy magnitude, sCT due to one π–π pair is also present, contributing to the differential stabilization of ferrous heme–CO bonding. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) poisoning is difficult to diagnose owing to its nonspecific symptoms. Multiwave pulse oximetry can be used to quickly screen patients for CO poisoning. However, few studies have analyzed patients with CO poisoning who presented to the emergency department (ED). The primary aim of our study was to determine the correlation between COHb levels measured in blood gas analysis and COHb levels measured in multiwave pulse oximetry. Secondary aims were the sensitivity and specificity of the COHb level cutoff value using multiwave pulse oximetry to predict a 25% COHb level in blood gas analysis. This single-center retrospective observational study included patients with CO poisoning who visited the ED of a university-affiliated hospital in Seoul, Korea between July 2021 and June 2023. COHb poisoning was determined using blood gas analysis and multiwave pulse oximetry. The correlation of COHb levels between the two tests was evaluated using correlation analysis. The area under the receiver operating characteristic curve (AUC) of multiwave pulse oximetry was calculated to predict COHb levels from the blood gas analysis. The optimal cutoff values, sensitivity, and specificity of COHb were determined. A total of 224 patients who had COHb levels measured using both multiwave pulse oximetry and blood gas analysis were included in the analysis. In the correlation analysis, COHb showed a high positive correlation with COHb measured using blood gas analysis (Spearman correlation coefficient = 0.86, p < 0.001). The AUC of COHb measured by multiwave pulse oximetry to predict 25% of the COHb level (which can be an indication of hyperbaric oxygen treatment) measured by blood gas analysis was 0.916. When the COHb levels measured with multiwave pulse oximetry were 20% the sensitivity was 81% and the specificity was 83%, and when the COHb levels were 25% the sensitivity was 50% and the specificity was 95%. The COHb value measured using multiwave pulse oximetry blood gas analysis showed a high correlation. However, additional research using large-scale studies is required for validation. [ABSTRACT FROM AUTHOR]

Recently, myriad studies have defined the versatile abilities of gasotransmitters and their synthesizing enzymes to play a "Maestro" role in orchestrating several oncological and non-oncological circuits and, thus, nominated them as possible therapeutic targets. Although a significant amount of work has been conducted on the role of nitric oxide (NO) and carbon monoxide (CO) and their inter-relationship in the field of oncology, research about hydrogen sulfide (H2S) remains in its infancy. Recently, non-coding RNAs (ncRNAs) have been reported to play a dominating role in the regulation of the endogenous machinery system of H2S in several pathological contexts. A growing list of microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) are leading the way as upstream regulators for H2S biosynthesis in different mammalian cells during the development and progression of human diseases; therefore, their targeting can be of great therapeutic benefit. In the current review, the authors shed the light onto the biosynthetic pathways of H2S and their regulation by miRNAs and lncRNAs in various oncological and non-oncological disorders. [ABSTRACT FROM AUTHOR]

Simple Summary: Brachycephalic dogs are more prone to develop upper airway respiratory complications in the postoperative period. The application of pre- and postoperative continuous positive airway pressure (CPAP) therapy has been suggested in human patients with obstructive sleep apnea to enhance oxygenation, diminish airway swelling, reduce the work of breathing, and promote recovery. Brachycephalic dogs undergoing various surgical procedures were included in this study and assigned to receive either standard oxygen supplementation (NO-CPAP group) or oxygen supplementation combined with CPAP (CPAP group). The CPAP group showed significant improvements in respiratory function compared with the NO-CPAP group (p < 0.001). The incidence of reintubation and helmet intolerance was higher in the NO-CPAP group (18% and 15.6%, respectively) than in the CPAP group (0%). This study highlights the potential benefits of incorporating CPAP, delivered through a pediatric helmet, in the perioperative management of brachycephalic dogs. This study aimed to evaluate the benefits of applying 5 cmH2O of CPAP using a pediatric helmet during the recovery phase from general anesthesia in brachycephalic dogs. Brachycephalic dogs undergoing various surgical procedures were included in this study, and a total of 64 subjects were randomly assigned to receive either standard oxygen supplementation (NO-CPAP group) or oxygen supplementation combined with CPAP (CPAP group). This study evaluated arterial blood pH, blood gas partial pressures of O2 and CO2, arterial blood O2 saturation, and related parameters during recovery. The dogs were monitored, and helmet tolerance was assessed using predefined criteria. Of the initially assessed 69 dogs, 64 were enrolled: 32 in the CPAP group and 32 in the NO-CPAP group. Fifteen dogs in the NO-CPAP group were excluded based on predetermined criteria. The CPAP group showed significant improvements in PaO2, PaO2/FiO2, P(A-a)O2, F-Shunt, and respiratory rate compared with the NO-CPAP group (p < 0.001). The incidence of reintubation and helmet intolerance was higher in the NO-CPAP group (18% and 15.6%, respectively) than in the CPAP group (0%). This study highlights the potential benefits of incorporating CPAP, delivered through a pediatric helmet, in the perioperative management of brachycephalic dogs. [ABSTRACT FROM AUTHOR]

A photoacoustic sensor system (PAS) intended for carbon dioxide (CO2) blood gas detection is presented. The development focuses on a photoacoustic (PA) sensor based on the so-called two-chamber principle, i.e., comprising a measuring cell and a detection chamber. The aim is the reliable continuous monitoring of transcutaneous CO2 values, which is very important, for example, in intensive care unit patient monitoring. An infrared light-emitting diode (LED) with an emission peak wavelength at 4.3 µm was used as a light source. A micro-electro-mechanical system (MEMS) microphone and the target gas CO2 are inside a hermetically sealed detection chamber for selective target gas detection. Based on conducted simulations and measurement results in a laboratory setup, a miniaturized PA CO2 sensor with an absorption path length of 2.0 mm and a diameter of 3.0 mm was developed for the investigation of cross-sensitivities, detection limit, and signal stability and was compared to a commercial infrared CO2 sensor with a similar measurement range. The achieved detection limit of the presented PA CO2 sensor during laboratory tests is 1 vol. % CO2. Compared to the commercial sensor, our PA sensor showed less influences of humidity and oxygen on the detected signal and a faster response and recovery time. Finally, the developed sensor system was fixed to the skin of a test person, and an arterialization time of 181 min could be determined. [ABSTRACT FROM AUTHOR]

Summary 1: The first article discusses a study comparing biodosimetry and physical dosimetry techniques for estimating radiation dose in emergency situations. The study found that physical dosimetry using smartphone components can estimate high-energy (gamma ray) exposure well, but overestimates x-ray exposure.Summary 2: The second article presents a cross-sectional study of suicides in Australia, focusing on substances detected during postmortem toxicology analyses. The study found that psychotropic medications and potentially intoxicating medications/drugs were found at high rates in both poisoning- and non-poisoning-related suicides.Summary 3: The third article examines the administration of Centruroides (scorpion) antivenom and investigates the rate of serious adverse events when the antivenom is given as a slow intravenous push. The study found that the administration of antivenom via slow intravenous push (sIVP) was safe and effective when given by trained staff. [Extracted from the article]

Introduction: Carbon monoxide (CO) is a colorless and odorless gas that is a leading cause of environmental poisoning in the USA with substantial mortality and morbidity. The mechanism of CO poisoning is complex and includes hypoxia, inflammation, and leukocyte sequestration in brain microvessel segments leading to increased reactive oxygen species. Another important pathway is the effects of CO on the mitochondria, specifically at cytochrome c oxidase, also known as Complex IV (CIV). One of the glaring gaps is the lack of rigorous experimental models that may recapitulate survivors of acute CO poisoning in the early phase. The primary objective of this preliminary study is to use our advanced swine platform of acute CO poisoning to develop a clinically relevant survivor model to perform behavioral assessment and MRI imaging that will allow future development of biomarkers and therapeutics. Methods: Four swine (10 kg) were divided into two groups: control (n = 2) and CO (n = 2). The CO group received CO at 2000 ppm for over 120 min followed by 30 min of re-oxygenation at room air for one swine and 150 min followed by 30 min of re-oxygenation for another swine. The two swine in the sham group received room air for 150 min. Cerebral microdialysis was performed to obtain semi real-time measurements of cerebral metabolic status. Following exposures, all surviving animals were observed for a 24-h period with neurobehavioral assessment and imaging. At the end of the 24-h period, fresh brain tissue (cortical and hippocampal) was immediately harvested to measure mitochondrial respiration. Results: While a preliminary ongoing study, animals in the CO group showed alterations in cerebral metabolism and cellular function in the acute exposure phase with possible sustained mitochondrial changes 24 h after the CO exposure ended. Conclusions: This preliminary research further establishes a large animal swine model investigating survivors of CO poisoning to measure translational metrics relevant to clinical medicine that includes a basic neurobehavioral assessment and post exposure cellular measures. [ABSTRACT FROM AUTHOR]

The main method for estimating the level of arterial blood oxygenation is pulse oximetry, which has the advantages of being fast, simple, reliable, and non-invasive. However, in well-known pulse oximeters, oxygen saturation is determined only by hemoglobin functional fractions, which reduces the device accuracy and is unacceptable in certain clinical cases. The known pulse oximeter improvement that considers the dysfunctional fraction concentration, especially carboxyhemoglobin, when measuring the level of blood oxygenation is an actual scientific and technical task. The research subjects. Mathematical, algorithmic, and technical support of a pulse oximeter that measures blood oxygenation levels considering the carboxyhemoglobin concentration. Objective. To expand the pulse oximeter functionality to consider the concentration of carboxyhemoglobin in arterial blood. Methods. Methods of computer simulation for developing a model and estimating the pulse oximeter accuracy that measures the blood oxygenation level considering the carboxyhemoglobin concentration. Results. The theoretical statements of measuring the level of blood oxygenation considering the carboxyhemoglobin concentration and the simplest pulse oximeter structural diagram for measuring are developed. An additional LED used in the pulse oximeter is proposed, and the wavelength choice is justified on the condition of maximizing the carboxyhemoglobin contribution to the optical density of the biological object. Computer models of a traditional pulse oximeter and a pulse oximeter with an additional LED were developed, simulation research was conducted using the developed models, and the device accuracy for measuring the level of blood oxygenation was estimated considering the carboxyhemoglobin concentration. Conclusions. Simulation studies based on the developed models show that the proposed pulse oximeter, compared with the known one, allows determining and estimating a decrease in blood oxygenation caused by the carboxyhemoglobin concentration increasing in the patient's blood. Considering that light is also absorbed by the third derivative of hemoglobin, carboxyhemoglobin, increases the accuracy of the proposed pulse oximeter in measuring functional saturation. [ABSTRACT FROM AUTHOR]

The experimental study was conducted to investigate the effect of using Cresson oil biodiesel on CI engine emissions and performance. This research aimed to examine how using innovative biodiesel blend formulations made from Cresson oil affected the performance and emissions of CI engines. The proportion of Cresson oil biodiesel added to conventional Iraqi diesel fuel into volume amounted to 10%, 20%, 40%, 60%, 80%, and 100%. The engine compression ratio was set to 18, and the fuel injection timing was set at 23° bTDC. The experiments show that this biodiesel reduces the thermal efficiency, heat release, delay time, and cylinder pressure of the engine while increasing the exhaust temperature (EGT) and brake-specific fuel consumption (BSFC). There has been an increase in emissions of nitrogen oxides (NOX) and carbon dioxide (CO2), in addition to a reduction in emissions of carbon monoxide (CO), soot, and unburned hydrocarbons (HC). [ABSTRACT FROM AUTHOR]

Context: Carbon monoxide (CO) concentrations in exhaled air may impart a quick, non-invasive method to determine smoking status. Haras is a nutraceutical medication, which is slowly gaining recognition for its antioxidant and anti-inflammatory activities. Aims: The effectiveness of the Haras therapy in smokers and non-smokers will be assessed by evaluating breath CO levels. Methods and Materials: The study included 101 test subjects with 76 subjects of smokers and 25 subjects of non-smokers. Both the test groups were given 10 mL of Haras juice in divided doses per day for 30 days. The CO levels were evaluated using a breath analyser before drug trial and then on the 8th, 15th, 22nd and after the conclusion of the drug trial. Statistical Analysis Used: The Wilcoxon signed-rank test was used to compare the CO and carboxyhemoglobin levels among smokers and non-smokers. Results: Smokers had higher mean percent carboxyhemoglobin and mean parts per million CO values than non-smokers, and the difference between the two was shown to be statistically significant (P < 0.001). It was also found to be statistically significant from the first day to the eighth day, the first day to the 15th day, the first day to the 20th second day, first day to the 30th day (P < 0.001). Conclusions: Haras can be used effectively as an alternative supportive treatment for the diminution of CO levels in smokers and non-smokers. [ABSTRACT FROM AUTHOR]

This study investigated the utility of periostin, a matricellular protein, as a prognostic biomarker in patients with idiopathic pulmonary fibrosis (IPF) who received nintedanib. Monomeric and total periostin levels were measured by enzyme-linked immunosorbent assay in 87 eligible patients who participated in a multicenter prospective study. Forty-three antifibrotic drug-naive patients with IPF described in previous studies were set as historical controls. Monomeric and total periostin levels were not significantly associated with the change in forced vital capacity (FVC) or diffusing capacity of the lungs for carbon monoxide (DLCO) during any follow-up period. Higher monomeric and total periostin levels were independent risk factors for overall survival in the Cox proportional hazard model. In the analysis of nintedanib effectiveness, higher binarized monomeric periostin levels were associated with more favorable suppressive effects on decreased vital capacity (VC) and DLCO in the treatment group compared with historical controls. Higher binarized levels of total periostin were associated with more favorable suppressive effects on decreased DLCO but not VC. In conclusion, higher periostin levels were independently associated with survival and better therapeutic effectiveness in patients with IPF treated with nintedanib. Periostin assessments may contribute to determining therapeutic strategies for patients with IPF. [ABSTRACT FROM AUTHOR]

Background: The heme oxygenase-1 (HO-1) enzyme pathway is of crucial importance in the removal of toxic blood components and regulation of neuroinflammation following hemorrhagic stroke. Although a circadian pattern dependency in the incidence and severity of hemorrhagic stroke exists, it is unknown whether the activity of the HO-1 system in the context of hemorrhagic injury also exhibits circadian dependency. We hypothesized that the circadian regulation of microglial HO-1 would determine the extent of neuroinflammation and neuronal injury in a murine model of subarachnoid hemorrhage (SAH). Methods: In vitro expression patterns of HO-1 and circadian rhythm genes were analyzed in the microglial BV-2 cell line and primary microglia (PMG) using Western blot and qPCR. PMG isolated from Hmox1fl/fl and LyzM-Cre-Hmox1fl/fl mice were used to evaluate the role of microglial HO-1. We further investigated the in vivo relevance in a murine subarachnoid hemorrhage (SAH) model using Hmox1fl/fl and LyzM-Cre-Hmox1fl/fl mice with myeloid cell HO-1 deficiency, inducing SAH at different zeitgeber (ZT) times and analyzing the expression of HO-1 and the circadian control gene Period-2 (Per-2), respectively. Furthermore, we measured the inflammatory cytokine Monocyte Chemoattractant Protein-1 (MCP-1) in the cerebrospinal fluid of SAH patients in correlation with clinical outcome. Results: HO-1 baseline expression and response to CO with blood exposure depended on ZT. In vitro expression of circadian control genes was de-synchronized in LyzM-Cre-Hmox1fl/fl PMG and did not respond to exogenous CO exposure. We found that circadian rhythm plays a crucial role in brain damage after SAH. At ZT2, we observed less phagocytic function, more vasospasm and increased microglial activation. CO reduced mortality at ZT12 in HO-1 deficient mice and reduced the difference between ZT2 and ZT12 in the inflammatory response. Induction of MCP-1 in the CSF from SAH patients was time-dependent and correlated with the expression of circadian control genes, SAH severity, functional impairment and delirium. Conclusions: Our data point towards a crucial role for the HO-1 enzyme system and circadian control in neuronal injury after a hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Fire-related deaths are usually a consequence of carbon monoxide (CO) poisoning or shock from thermal injuries. In humans, high levels of carboxyhemoglobin (COHb) concentrations in the blood can support a diagnosis of CO poisoning. In veterinary medicine, few studies investigated the pathological changes and blood COHb% in fire victims, and no data are available on post-mortem changes in blood gas composition due to fire. This study aims to investigate the pathological changes and COHb levels in both animal victims of fire and cadavers experimentally exposed to fire. For this purpose, dogs were selected and subdivided into three groups. Group A comprised 9 adult dogs, and Group B comprised 7 puppies that died under fire-related conditions. Group C was represented by 4 dog cadavers experimentally exposed to heat and smoke. A complete macroscopic, histological, and COHb evaluation were performed on each animal. Animals in Groups A and B showed cherry-red discoloration, thermal-injuries and soot deposits along the respiratory tract. Animals in Group C showed thermal injuries and soot deposits limited to the upper respiratory tract. The mean COHb% values in cadavers in Group C were lower than those observed in the other groups but higher compared to the values detected before the heat and smoke treatment. These findings suggest that both pathological changes and COHb analysis are valid tools for investigating fire-related deaths in dogs. However, the increase of COHb levels in cadavers exposed post-mortem to heat and smoke highlights how the COHb analysis should always be evaluated together with macroscopical and microscopical findings to avoid significant misjudgments in investigating fire-related fatalities in veterinary forensic practice.

Background: Decreased systemic oxygen delivery derived from gas exchange abnormalities in severe hemolysis complicates patients requiring mechanical circulatory support devices. Severe hemolysis releases free hemoglobin in plasma causing elevation of carboxyhemoglobin and methemoglobin levels. Hemolysis-induced decline in hemoglobin and oxyhemoglobin saturation significantly reduces the arterial oxygen content in blood, reducing systemic oxygen delivery. These patients develop hypoxemia with misleadingly normal oxygen saturation measured by standard pulse oximetry. Methods: Retrospective review of 2 clinical cases reaching carboxyhemoglobin and methemoglobin levels > 2% while supported with an Impella device. Results: Case 1. Patient with cardiogenic shock refractory to maximal medical therapy required insertion of Impella device achieving improvement in cardiac output, pulse oximetry, arterial oxygen saturation and systemic oxygen delivery. The device caused significant hemolytic anemia with severe decline in hemoglobin and arterial oxygen saturation with elevation of carboxyhemoglobin and methemoglobin levels, causing drastic reduction in systemic oxygen delivery despite adequate cardiac output. Device removal reversed severe hemolytic anemia, causing increased arterial oxygen saturation and systemic oxygen delivery despite borderline cardiac output.Case 2. Patient with refractory cardiogenic shock improved after insertion of Impella device. Initial improvement cardiac output and systemic oxygen delivery was negated by hemolytic anemia associated with elevation of carboxyhemoglobin and methemoglobin levels. Hemolysis decreased by reducing the Impella power output. Carboxyhemoglobin and methemoglobin levels correlated precisely with degree of hemolysis allowing to titrate therapy to best systemic oxygen delivery. Conclusions: Monitoring carboxyhemoglobin and methemoglobin levels readily identifies patients with ongoing hemolysis secondary to invasive supportive devices.

IntroductionAcute carbon monoxide poisoning (COP) is one of the leading causes of intoxication among patients presenting to the emergency department (ED). COP symptoms are not always specific and may vary from mild to critical. In the last few years, COHb pulse oximeters have been developed and applied to the setting of suspected COP. The aim of this systematic review is to assess the diagnostic accuracy of CO pulse oximetry (SpCO) with carboxyhemoglobin (COHb) levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP.MethodsWe developed our search strategy according to the PICOS framework, population, index/intervention, comparison, outcome, and study, considering the diagnostic accuracy of SpCO compared to COHb levels measured by blood gas analysis, used as a reference standard, in patients with suspected COP enrolled in cross-sectional studies in English. The search was performed on MEDLINE/PubMed and EMBASE in February 2022. Quality assessment was performed using the QUADAS-2 methodology. A COHb cutoff of 10% was chosen to test the sensitivity and specificity of the index test. A bivariate model was used to perform the meta-analysis. The protocol was registered on PROSPERO (CRD42022359144).ResultsA total of six studies (1734 patients) were included. The pooled sensitivity of the test was 0.65 (95% CI 0.44–0.81), and the pooled specificity was 0.93 (95% CI 0.83–0.98). The pooled LR+ was 9.4 (95% CI 4.4 to 20.1), and the pooled LR- was 0.38 (95% CI 0.24 to 0.62).ConclusionOur results show that SpCO cannot be used as a screening tool for COP in the ED due to its low sensitivity. Because of its high LR+, it would be interesting to evaluate, if SpCO could have a role in the prehospital setting as a tool to quickly identify COP patients and prioritize their transport to specialized hospitals on larger samples with a prospective design.

Background: The oxygen reserve index (ORi) is a real-time, continuous index measured with multi-wavelength pulse CO-oximetry technology. It estimates mild hyperoxemia in humans, which is defined as a partial pressure of oxygen (PaO2) level between 100 and 200 mmHg. The objectives of this study were to assess the correlation between ORi and PaO2, as well as to determine its ability in detecting mild hyperoxemia in dogs. Methods: This prospective observational study enrolled 37 anaesthetised and mechanically ventilated dogs undergoing elective procedures. Simultaneous measurements of ORi and PaO2 were collected, using a multi-wavelength pulse CO-oximeter with a probe placed on the dog's tongue, and a blood gas analyser, respectively. A mixed-effects model was used to calculate the correlation (r2) between simultaneous measurements of ORi and PaO2. The trending ability of ORi to identify dependable and proportional changes of PaO2 was determined. The diagnostic performances of ORi to detect PaO2 ≥ 150 mmHg and ≥ 190 mmHg were estimated using the area under the receiver operating characteristic curve (AUROC). The effects of perfusion index (PI), haemoglobin (Hb), arterial blood pH and partial pressure of carbon dioxide (PaCO2) on AUROC for PaO2 ≥ 150 mmHg were evaluated. Results: A total of 101 paired measurements of ORi and PaO2 were collected. PaO2 values ranged from 74 to 258 mmHg. A strong positive correlation (r2 = 0.52, p < 0.001) was found between ORi and PaO2. The trending ability ORi was 90.7%, with 92% sensitivity and 89% specificity in detecting decreasing PaO2. An ORi value ≥ 0.53 and ≥ 0.76 indicated a PaO2 ≥ 150 and ≥ 190 mmHg, respectively, with ≥ 82% sensitivity, ≥ 77% specificity and AUROC ≥ 0.75. The AUROC of ORi was not affected by PI, Hb, pH and PaCO2. Conclusions: In anaesthetised dogs, ORi may detect mild hyperoxaemia, although it does not replace blood gas analysis for measuring the arterial partial pressure of oxygen. ORi monitoring could be used to non-invasively assess oxygenation in dogs receiving supplemental oxygen, limiting excessive hyperoxia. [ABSTRACT FROM AUTHOR]

Acetogenic bacteria can utilize C1 compounds, such as carbon monoxide (CO), formate, and methanol, via the Wood-Ljungdahl pathway (WLP) to produce biofuels and biochemicals. Two novel acetogenic bacteria of the family Eubacteriaceae ES2 and ES3 were isolated from Eulsukdo, a delta island in South Korea. We conducted whole genome sequencing of the ES strains and comparative genome analysis on the core clusters of WLP with Acetobacterium woodii DSM1030T and Eubacterium limosum ATCC8486T. The methyl-branch cluster included a formate transporter and duplicates or triplicates copies of the fhs gene, which encodes formyltetrahydrofolate synthetase. The formate dehydrogenase cluster did not include the hydrogenase gene, which might be replaced by a functional complex with a separate electron bifurcating hydrogenase (HytABCDE). Additionally, duplicated copies of the acsB gene, encoding acetyl-CoA synthase, are located within or close to the carbonyl-branch cluster. The serum bottle culture showed that ES strains can utilize a diverse range of C1 compounds, including CO, formate, and methanol, as well as CO2. Notably, ES2 exhibited remarkable resistance to high concentrations of C1 substrates, such as 100% CO (200 kPa), 700 mM formate, and 500 mM methanol. Moreover, ES2 demonstrated remarkable growth rates under 50% CO (0.45 h-1) and 200 mM formate (0.34 h-1). These growth rates are comparable to or surpassing those previously reported in other acetogenic bacteria. Our study introduces novel acetogenic ES strains and describes their genetic and physiological characteristics, which can be utilized in C1-based biomanufacturing. [ABSTRACT FROM AUTHOR]

Addressing the burgeoning issue of polymer waste management and disposal, chemical recycling, specifically the production of highquality oil, presents an enticing solution. This research paper delves into the process of plastic waste pyrolysis, focusing on polypropylene, and thoroughly examines the physico-chemical properties of the resulting pyrolytic oil. The oils, obtained from waste plastic pyrolysis (referred to as WPPO), are then blended with kerosene and utilized as fuel for a gas turbine engine. The primary objective of this investigation is to ascertain how the blend composition influences the performance and emission parameters of the micro gas turbine. In our findings, it was observed that all tested waste plastic pyrolysis blends displayed a trend towards escalating regulated emissions such as nitrogen oxides (NOx) with an average increase of 26% for polypropylene pyrolysis oil (PPO). The emission index (EI) for carbon monoxide (CO) was found to be relatively consistent across all fuel blends tested in this study. Interestingly, when considering the thrust specific fuel consumption (TSFC) within the EI calculation, blends of aviation kerosene and plastic oil showed lower values in comparison to the pure Jet A-1 fuel. Furthermore, an augmentation in the proportion of WPPO in the blends consequently led to an elevation in the exhaust gas temperature (an average increase of 8.7% for PPO). Interestingly, the fuel efficiency of the Jet engine, expressed as TSFC, demonstrated a decrease, with an average reduction of 13.8% observed for PPO. [ABSTRACT FROM AUTHOR]

Hemoglobin C (HbC) disease is an uncommon disease that is generally considered benign, causing only occasionally painless hematuria, osteomyelitis, and dental abnormalities. Ocular manifestations have rarely been described in these patients. Here we report a novel ophthalmological manifestation of the disease. A 20-year-old woman presented with progressive visual loss in her right eye due to tractional retinal detachment. The left eye was apparently normal, but wide-field fluorescence angiography showed mild peripheral ischemia with multiple vascular abnormalities. Vitrectomy was performed and the systemic workup revealed the presence of hemoglobinopathy C in heterozygous form. HbC disease can be sight-threating due to retinal proliferation, similar to sickle cell retinopathy. Patients affected with this disease should undergo regular surveillance. Ultra-wide angiography is a helpful examination to detect peripheral ischemia in the earlier stages. [ABSTRACT FROM AUTHOR]

Metabolic-associated fatty liver disease (MAFLD) encompasses a spectrum of chronic liver diseases, including steatohepatitis, cirrhosis, and liver cancer. Despite the increasing prevalence and severity of MAFLD, no approved pharmacological interventions are currently available. Hypoxia-inducible factor-1α (HIF-1α) has emerged as a crucial early mediator in the pathogenesis of MAFLD. Previously, we demonstrated the potent anti-inflammatory properties of the nano-designed carbon monoxide (CO) donor, styrene maleic acid copolymer (SMA) encapsulating CO-releasing molecule (SMA/CORM2), which effectively suppressed HIF-1α in various inflammatory disorders. Here, we investigated the therapeutic potential of SMA/CORM2 in a mouse model of MAFLD induced by a high-fat methionine- and choline-deficient (HF-MCD) diet. Following 4 weeks of HF-MCD diet consumption, we observed pronounced hepatic lipid accumulation accompanied by disrupted lipid metabolism, polarization of macrophages towards the pro-inflammatory M1 phenotype, activation of the NLRP3 inflammasome, and upregulation of the TGF-β fibrosis signaling pathway. Notably, the early and upstream event driving these pathological changes was the upregulation of HIF-1α. Treatment with SMA/CORM2 (10 mg/kg, three times per week) led to a significant increase in CO levels in both the circulation and liver, resulting in remarkable suppression of HIF-1α expression even before the onset of apparent pathological changes induced by the HF-MCD diet. Consequently, SMA/CORM2 administration exerted a significantly protective and therapeutic effect on MAFLD. In vitro studies using hepatocytes treated with high concentrations of fatty acids further supported these findings, as knockdown of HIF-1α using short hairpin RNA (shRNA) elicited similar effects to SMA/CORM2 treatment. Collectively, our results highlight the therapeutic potential of SMA/CORM2 in the management of MAFLD through suppression of HIF-1α. We anticipate that SMA/CORM2, with its ability to modulate HIF-1α expression, may hold promise for future applications in the treatment of MAFLD. Carbon monoxide (CO) is a crucial gaseous signaling molecule that plays a vital role in maintaining homeostasis and is a potential target for treating many inflammatory diseases. Developing drug delivery systems that can deliver CO stably and target specific tissues is of great interest. Our team previously developed a nano micellar CO donor, SMA/CORM2, which exhibits superior bioavailability to native CORM2 and shows therapeutic potential in many inflammatory disease models. In this study, we showed that SMA/CORM2, through controlled CO release, significantly ameliorated steatohepatitis and liver fibrosis induced by an HF-MCD diet by suppressing an HIF-1α mediated inflammatory cascade. These findings provide new insight into the anti-inflammatory function of CO and a promising approach for controlling metabolic-associated fatty liver disease. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Carboxyhemoglobin saturation (SpCO)with pulse CO-oximetry is an alternative method in CO poisoning; however, the correlation of it with blood carboxyhemoglobin level (COHb) is still debated.The study aimed to evaluate the correlation between SpCO and venous COHb level and factors associated with the diagnostic accuracy of SpCO. Material and methods: SpCO and venous COHb levels of patients with CO poisoning, according to a COHb level was 3%, were evaluated. The sensitivity, specificity, 95% CI (confidence interval), and the cut-off value of SpCO were calculated using ROC analysis at a 10% threshold for COHb. Agreement levels were calculated with Bland-Altman analysis. Risk factors affecting diagnostic accuracy were analyzed using logistic regression analysis. Results: If the 10% threshold of COHb was accepted as the diagnostic threshold for CO poisoning, the sensitivity and specificity of SpCO were 98.4% and 100% (95% CI: 0.996-1.000) at the 6.85 cut-off point of SpCO. The scatter plot of COHb and SpCO showed a strong positive relationship at values of presentation and discharge (r = .979, p<0.001; r = .969, p<0.001). With a bias of 3.1% for the mean difference between-COHb and SpCO, the limits of agreement from Bland- Altman analysis were −0.7 to 7.1. For the 10% threshold, age and male gender have significantly increased false negativity rates (B = .074, p = 0.010, and B = 0.252, p = 0.011, respectively). Conclusion: SpCO is a reliable method with high sensitivity and specificity; therefore, a lower cut-off points of SpCO compared to COHb level may be accepted to diagnose and follow-up CO poisoning. [ABSTRACT FROM AUTHOR]

Zinc deficiency continues to be a major concern for global public health. The zinc status of a target population is typically estimated by measuring circulating zinc levels, but the sampling procedures are not standardized and thus may result in analytical discrepancies. To examine this, we designed a study that controlled most of the technical parameters in order to focus on five pre-analytical variables reported to influence the measurement of zinc in blood samples, including (1) blood draw site (capillary or venous), (2) blood sample matrix (plasma or serum), (3) blood collection tube manufacturer (Becton, Dickinson and Company or Sarstedt AG & Co), (4) blood processing time (0, 4, or 24 hours), and (5) blood holding temperatures (4°C, 20°C, or 37°C). A diverse cohort of 60 healthy adults were recruited to provide sequential capillary and venous blood samples, which were carefully processed under a single chain of custody and measured for zinc content using inductively coupled plasma optical emission spectrometry. When comparing blood draw sites, the mean zinc content of capillary samples was 0.054 mg/L (8%; p<0.0001) higher than venous blood from the same donors. When comparing blood sample matrices, the mean zinc content of serum samples was 0.029 mg/L (5%; p<0.0001) higher than plasma samples from the same donors. When comparing blood collection tube manufacturer, the mean zinc content from venous blood samples did not differ between venders, but the mean zinc content from BD capillary plasma was 0.036 mg/L (6%; p<0.0001) higher than Sarstedt capillary plasma from the same donors. When comparing processing times, the mean zinc content of plasma and serum samples was 5–12% higher (p<0.0001) in samples processed 4–24 hour after collection. When comparing holding temperatures, the mean zinc content of plasma and serum samples was 0.5–7% higher (p = 0.0007 or p = 0.0061, respectively) in samples temporarily held at 20°C or 37°C after collection. Thus even with the same donors and blood draws, significant differences in zinc content were observed with different draw sites, tube types, and processing procedures, demonstrating that key pre-analytic variables can have an impact on zinc measurement, and subsequent classification of zinc status. Minimizing these pre-analytical variables is important for generating best practice guidelines for assessment of zinc status. [ABSTRACT FROM AUTHOR]

An engine modelling study was conducted to investigate the relative change in performance and emissions of a 4-stroke, spark-ignition engine using Iraqi Associated Petroleum Gas as fuel. The research was done using a well-verified simulation software Diesel-RK. The data available for Ricardo E6/T variable compression ratio spark-ignition engine was used to conduct this study. The performance of the engine using associated petroleum gas was compared with those for gasoline, natural gas, and the average properties of the natural gas in Europe. The performance parameters studied were engine power, thermal efficiency, oxides of nitrogen, unburned hydrocarbon, and carbon monoxide levels. The study showed that the Iraqi associated petroleum gas could not be used "as is" if the aim is to cut down pollution. The main advantage is the absence of sulfur in the gas, which is present in the gasoline used in Iraq. There is a significant rise in NOx levels, a reduction in UHC, and also a rise in CO levels when using APG fuel. Further, there is an average reduction in engine power of about 10% with the associated gas compared with gasoline. At the same time, the only gain is the reduction in SFC and improvement in thermal efficiency with the new fuel. [ABSTRACT FROM AUTHOR]

Cisplatin-induced acute kidney injury (AKI) is an important factor that limits the clinical use of this drug for the treatment of malignancies. Oxidative stress and inflammation are considered to be the main causes of not only cisplatin-induced death of cancer cells but also cisplatin-induced AKI. Therefore, developing agents that exert antioxidant and anti-inflammatory effects without weakening the anti-tumor effects of cisplatin is highly desirable. Carbon monoxide (CO) has recently attracted interest due to its antioxidant, anti-inflammatory, and anti-tumor properties. Herein, we report that CO-loaded red blood cell (CO-RBC) exerts renoprotective effects on cisplatin-induced AKI. Cisplatin treatment was found to reduce cell viability in proximal tubular cells via oxidative stress and inflammation. Cisplatin-induced cytotoxicity, however, was suppressed by the CO-RBC treatment. The intraperitoneal administration of cisplatin caused an elevation in the blood urea nitrogen and serum creatinine levels. The administration of CO-RBC significantly suppressed these elevations. Furthermore, the administration of CO-RBC also reduced the deterioration of renal histology and tubular cell injury through its antioxidant and anti-inflammatory effects in cisplatin-induced AKI mice. Thus, our data suggest that CO-RBC has the potential to substantially prevent the onset of cisplatin-induced AKI, which, in turn, may improve the usefulness of cisplatin-based chemotherapy. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) poisoning during pregnancy is a rare occurrence, associated with high maternal and fetal mortality rates. As CO can cross the placenta, leading to intrauterine hypoxia, CO intoxication can result in neurological sequelae and neurologic complications in fetuses who survive. We report a case of a preterm newborn acutely exposed to CO in-utero and delivered by emergent cesarean section at the 31st week of gestation due to the severe burns suffered by the mother following an indoor boiler explosion. As CO has serious adverse effects both on the mother and fetus, it is important to recognize and treat poisoning in a timely manner. Despite maternal blood CO levels, CO intoxication at critical stage of central nervous system development can lead to hypoxic-ischemic lesions, thus interdisciplinary care and follow up for these patients are mandatory.

The pink teeth phenomenon has occasionally been observed in forensic autopsies. This study aimed to establish an experimental pink tooth model and an objective color tone evaluation method in order to clarify changes in the color tone of teeth and the relationship with hemoglobin monoxide and its decomposition products and with red pigment-producing bacteria, under various external environmental factors. It was confirmed that the color tone evaluation with ΔE and the L*C*h color space was useful. The results of various examinations using this model showed that color development was suppressed under aerobic conditions, faded early under light, became bright red under a low temperature and showed a tendency to be reddish at 3 days under high humidity and in the presence of soft tissue. The biochemical analysis revealed a significant increase in carboxyhemoglobin at 7 days and a tendency toward increasing the total heme pigment and bilirubin levels over time. The bacteriological analysis revealed that red pigment-producing bacteria increased over time but that the color faded after 7 days. These results suggest that putrefaction greatly affects the pink teeth phenomenon, whereas red pigment-producing bacteria have little effect on the occurrence of pink teeth. However, further studies are needed to clarify bacteriological involvement. [ABSTRACT FROM AUTHOR]

Background: The single breath diffusion capacity for carbon monoxide (DLCO) captures several aspects of the role of the lung in meeting the metabolic demands of the body. The magnitude of the independent contributors to the DLCO is unknown. The aim of this study was to investigate the factors that independently contribute to the DLCO. Objectives: The objective was to investigate the impact of height, age, sex and haemoglobin on DLCO, alveolar volume (VA) and carbon monoxide transfer coefficient (KCO). Methods: Study participants were pre-screened based on normal exercise capacity achieved during an incremental cardio-pulmonary exercise testing (CPET) using cycle ergometry at McMaster University Medical Center between 1988–2012. Participants who had an FEV1>80% predicted, with an FEV1/FVC ≥0.7 and who achieved a maximum power output ≥80% were selected for analysis. In total, 16,298 subjects [61% male, mean height 1.70m (range 1.26–2.07), age 49 yrs (10–94), weight 79 kg (23–190) had DLCO measured while demonstrating normal spirometry and exercise capacity. Results: The DLCO increased exponentially with height, was 15% greater in males, increased with age yearly until 20, then decreased yearly after the age of 35, and was 6% higher per gram of haemoglobin (5.58*Height(m)1.69*1.15 in Males*(1–0.006*Age>35)*(1+0.01*Age<20) *(1+0.06*Hb gm/dl), (r = 0.76). Conclusion: Height, age, sex, and haemoglobin all have independent influence on the DLCO in subjects with normal spirometry and preserved exercise capacity. [ABSTRACT FROM AUTHOR]

We designed a photo-ECMO device to speed up the rate of carbon monoxide (CO) removal by using visible light to dissociate CO from hemoglobin (Hb). Using computational fluid dynamics, fillets of different radii (5 cm and 10 cm) were applied to the square shape of a photo-ECMO device to reduce stagnant blood flow regions and increase the treated blood volume while being constrained by full light penetration. The blood flow at different flow rates and the thermal load imposed by forty external light sources at 623 nm were modeled using the Navier-Stokes and convection–diffusion equations. The particle residence times were also analyzed to determine the time the blood remained in the device. There was a reduction in the blood flow stagnation as the fillet radii increased. The maximum temperature change for all the geometries was below 4 °C. The optimized device with a fillet radius of 5 cm and a blood priming volume of up to 208 cm3 should decrease the time needed to treat CO poisoning without exceeding the critical threshold for protein denaturation. This technology has the potential to decrease the time for CO removal when treating patients with CO poisoning and pulmonary gas exchange inhibition. [ABSTRACT FROM AUTHOR]

Introduction: In pulmonary hypertension (PH), pulmonary arterial remodeling is often accompanied by perivascular inflammation. The inflammation is characterized by the accumulation of activated macrophages and lymphocytes within the adventitial stroma, which is comprised primarily of fibroblasts. The well-known ability of fibroblasts to secrete interleukins and chemokines has previously been implicated as contributing to this tissue-specific inflammation in PH vessels. We were interested if pulmonary fibroblasts from PH arteries contribute to microenvironmental changes that could activate and polarize T-cells in PH. Methods: We used single-cell RNA sequencing of intact bovine distal pulmonary arteries (dPAs) from PH and control animals and flow cytometry, mRNA expression analysis, and respirometry analysis of blood-derived bovine/human T-cells exposed to conditioned media obtained from pulmonary fibroblasts of PH/control animals and IPAH/control patients (CM-(h)PH Fibs vs CM-(h)CO Fibs). Results: Single-cell RNA sequencing of intact bovine dPAs from PH and control animals revealed a pro-inflammatory phenotype of CD4+ T-cells and simultaneous absence of regulatory T-cells (FoxP3+ Tregs). By exposing T-cells to CM-(h)PH Fibs we stimulated their proinflammatory differentiation documented by increased IFNg and decreased IL4, IL10, and TGFb mRNA and protein expression. Interestingly, we demonstrated a reduction in the number of suppressive T-cell subsets, i.e., human/bovine Tregs and bovine gd T-cells treated with CM-(h)PH-Fibs. We also noted inhibition of anti-inflammatory cytokine expression (IL10, TGFb, IL4). Pro-inflammatory polarization of bovine T-cells exposed to CM-PH Fibs correlated with metabolic shift to glycolysis and lactate production with increased prooxidant intracellular status as well as increased proliferation of T-cells. To determine whether metabolic reprogramming of PH-Fibs was directly contributing to the effects of PH-Fibs conditioned media on T-cell polarization, we treated PH-Fibs with the HDAC inhibitor SAHA, which was previously shown to normalize metabolic status and examined the effects of the conditioned media. We observed significant suppression of inflammatory polarization associated with decreased T-cell proliferation and recovery of mitochondrial energy metabolism. Conclusion: This study demonstrates how the pulmonary fibroblast-derived microenvironment can activate and differentiate T-cells to trigger local inflammation, which is part of the vascular wall remodeling process in PH. [ABSTRACT FROM AUTHOR]