The ability to maintain proper airway surface liquid (ASL) volume homeostasis is vital for mucus hydration and clearance, which are essential aspects of the mammalian lung’s innate defense system. In ...cystic fibrosis (CF), one of the most common life-threatening genetic disorders, ASL dehydration leads to mucus accumulation and chronic infection. In normal airways, the secreted protein short palate lung and nasal epithelial clone 1 (SPLUNC1) effectively inhibits epithelial Na ⁺ channel (ENaC)-dependent Na ⁺ absorption and preserves ASL volume. In CF airways, it has been hypothesized that increased ENaC-dependent Na ⁺ absorption contributes to ASL depletion, and hence increased disease. However, this theory is controversial, and the mechanism for abnormal ENaC regulation in CF airways has remained elusive. Here, we show that SPLUNC1 is a pH-sensitive regulator of ENaC and is unable to inhibit ENaC in the acidic CF airway environment. Alkalinization of CF airway cultures prevented CF ASL hyperabsorption, and this effect was abolished when SPLUNC1 was stably knocked down. Accordingly, we resolved the crystal structure of SPLUNC1 to 2.8 Å. Notably, this structure revealed two pH-sensitive salt bridges that, when removed, rendered SPLUNC1 pH-insensitive and able to regulate ASL volume in acidic ASL. Thus, we conclude that ENaC hyperactivity is secondary to reduced CF ASL pH. Together, these data provide molecular insights into the mucosal dehydration associated with a range of pulmonary diseases, including CF, and suggest that future therapy be directed toward alkalinizing the pH of CF airways.
These guidelines update and extend evidence-based indications for the management of children with acute gastroenteritis in Europe.
The guideline development group formulated questions, identified ...data, and formulated recommendations. The latter were graded with the Muir Gray system and, in parallel, with the Grading of Recommendations, Assessment, Development and Evaluations system.
Gastroenteritis severity is linked to etiology, and rotavirus is the most severe infectious agent and is frequently associated with dehydration. Dehydration reflects severity and should be monitored by established score systems. Investigations are generally not needed. Oral rehydration with hypoosmolar solution is the major treatment and should start as soon as possible. Breast-feeding should not be interrupted. Regular feeding should continue with no dietary changes including milk. Data suggest that in the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered in the management of gastroenteritis. Active therapy may reduce the duration and severity of diarrhea. Effective interventions include administration of specific probiotics such as Lactobacillus GG or Saccharomyces boulardii, diosmectite or racecadotril. Anti-infectious drugs should be given in exceptional cases. Ondansetron is effective against vomiting, but its routine use requires safety clearance given the warning about severe cardiac effects. Hospitalization should generally be reserved for children requiring enteral/parenteral rehydration; most cases may be managed in an outpatients setting. Enteral rehydration is superior to intravenous rehydration. Ultrarapid schemes of intravenous rehydration are not superior to standard schemes and may be associated with higher readmission rates.
Acute gastroenteritis is best managed using a few simple, well-defined medical interventions.
Dehydration results from a decrease in total body water content either due to less intake or more fluid loss. Common symptoms of dehydration are dry mouth/tongue, thirst, headache, and lethargy. The ...aim of this study was to assess knowledge of dehydration definition, symptoms, causes, prevention, water intake recommendations and water intake practices among people living in Riyadh, Saudi Arabia.
A cross-sectional study using self-reported questionnaire was employed. Participants were invited during their visit to shopping malls. The shopping malls were selected based on geographical location covering east, west, north and southern part of the city. Self-filled questionnaires were distributed to 393 participants, using systematic sampling technique. Variables recorded included demographics, past medical history, knowledge of dehydration definition, symptoms, causes, prevention and daily water intake practices. Descriptive statistics were summarised as mean, standard deviation and proportions. Negative binomial model was used to identify the predictors of water intake. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).
Out of 393 participants, 273(70%) were Saudi, 209(53%) were female, average age was 32.32 ± 8.78 years. Majority 366(93%) had good knowledge of dehydration definition, 332(84%) for dehydration prevention, and 293(74%) of water intake recommendation. Top three recognized dehydration symptoms were: dry lips (87%), thirst (84%), dry tongue (76%) and recognized dehydration causes were: diarrhoea (81%), sweating (68%) and vomiting (62%). The less recognized symptoms were fatigue 176(44.78%), lack of focus 171(43.5%), headache/dizziness 160(40.71%), light headedness 117(29.7%), muscle weakness 98(24.94%), rapid breathing 90(22.9%), and muscle cramps 64(16.28%).The participants had reported an average of 5.39 ± 3.32 water glasses intake per day. The total volume of water intake was significantly different between males n = 184 (3.935 ± 2.10 l) and females n = 209 (3.461 ± 2.59 l) (p = 0.046). The participants' weight status, intake of juice or tea were the significant predictors of more water intake.
The participants displayed good knowledge of dehydration definition, prevention, and water intake recommendation. The participants also displayed good knowledge of the common symptoms, however knowledge was lacking for uncommon symptoms. Moreover, participants had reported adequate water intake, meeting the daily water intake recommendation of ≥3.7 l for men and ≥ 2.7 l for women.
Hydrogel‐based electronics have found widespread applications in soft sensing and health monitoring because of their remarkable biocompatibility and mechanical features similar to human skin. ...However, they are subjected to potential challenges like structural failure, functional degradation, and device delamination in practical applications, especially facing extreme environmental conditions (e.g., abnormal temperature and humidity). To address these, ionically conductive organohydrogel‐based soft electronics are developed, which can perform at subzero and elevated temperatures (thermal compatibility) as well as at dehydrated and hydrated environments (hydration compatibility) for extended applications. More specifically, gelatin/poly(acrylic acid–N‐hydrosuccinimide ester) (PAA–NHS ester)‐based ionic‐conductive organohydrogel is synthesized. By introducing a glycerol–water binary solvent system, the gel can maintain mechanical softness in a wide temperature range (from −80 to 60 °C). Besides, excellent conductivity is achieved under various conditions by soaking the gel into lithium chloride anhydrous (LiCl) solution. Strong adhesion with skin, even under water, can be realized by covalent bonds between NHS ester from gel and amino groups from human skin. The excellent performances of LiCl‐loaded PAA‐based organohydrogel (L‐PAA‐OH)‐based electronics are further demonstrated under freezing and high temperatures as well as underwater conditions, unveiling their promising prospects in wearable health monitoring in various conditions.
An environmentally compatible organohydrogel is developed, showing excellent conductivity, stretchability, and strong adhesion in a wide temperature range and wet environment. Such advantageous features ensure the reliable electromechanical performance and robust integration to skin and thus pave the way for next‐generation wearable sensors.
We synthesize a Sn-modified MIL-101(Fe), which can confine Pt to the single-atom scale. This novel Pt@MIL(FeSn) catalyst efficiently hydrogenates levulinic acid to γ-valerolactone (TOF: 1386 h
−1
, ...yield: >99%) at only 100 °C and 1 MPa of H
2
via
α-angelica lactone as an intermediate. This could be the first report on switching the reaction path from 4-hydroxypentanoic acid to α-angelica lactone under very mild conditions. Incorporating Sn into MIL-101(Fe) enables the creation of abundant micro-pores less than 1 nm and Lewis acidic sites that stabilize Pt
0
atoms. The ensemble of active Pt atoms and a Lewis acid can synergistically enhance adsorption of the C&z.dbd;O bond and facilitate dehydrative cyclization of levulinic acid.
A Sn-modified MIL-101(Fe) confined single-atom Pt catalyst was synthesized, enabling efficient hydrogenation of levulinic acid to γ-valerolactone through α-angelica lactone as an intermediate under mild conditions.
The objective of this randomized controlled trial was to assess the relative merits of offering unweaned calves 3 different types of diets to meet energy and water deficits that can occur during ...journeys. Six young unweaned male Holstein calves were randomly selected from within 2 body weight ranges (median 48 and 42 kg) from each of 29 loads (total n = 174 calves) transported from an auction market or a collection center to a calf sorting center before transport to a veal unit. The calves were then randomly allocated to one of 3 dietary treatments (n = 58 calves/dietary treatment). They were offered either a milk replacer diet (M), a glucose-electrolyte diet (G) or a whey-based diet with added electrolytes (W). The ability of these diets to provide sufficient nutrient energy to restore vigor, avoid hypoglycaemia and clinical signs of dehydration without increasing the risk of diarrhea was assessed. A clinical assessment of dehydration, health and vigor was made, and the calves were blood sampled before feeding, then 2 h and 4 h after feeding. The plasma glucose concentration was increased 2 h and 4 h after feeding the M and W diets. The increases in plasma glucose concentration were greater 2 and 4 h after (a) feeding the M than after the W diet and (b) feeding the M and W diets than after the G diet. Back-transformed means and 95% Confidence Intervals (CI) for the ratio of the plasma glucose concentration at 4 h compared with 0 h for the milk replacer, glucose-electrolytes and whey-based diets were 1.2 mM CI 1.21, 1.35; 0.95 mM CI 0.92, 0.97; and 1.09 mM CI 1.06, 1.14, respectively. There was no effect of diet on the change in serum total protein concentration between before feeding and 2 and 4 h after feeding. The serum osmolality was lower 2 h after feeding the G diet. The fall in serum osmolality was greater 2 h after feeding the G diet than after feeding the M and W diets. The changes in the serum osmolality between before feeding and 2 h after feeding for the milk replacer, glucose-electrolytes and whey-based diets were −0.68 mosmol CI −3.27, 1.91; −5.23 mosmol CI −7.82, and −2.64; −0.13 mosmol CI −2.77, 2.51, respectively. The diet offered at the sorting center had no effect on subsequent growth on the veal rearing farm between arrival and slaughter (milk replacer 1.22 kg/d, CI 1.17, 1.28; glucose-electrolyte diet 1.23 kg/d. CI 1.18, 1.28; whey-based diet 1.28 kg/d CI 1.23, 1.33). The M diet provided the calves with nutrients and water to replace energy and water deficits that had accumulated before arrival at the sorting center, and these dietary benefits were still apparent 4 h after feeding. The benefits of the W diet were similar to those of the M diet, but the M diet was better able to assist the calves in maintaining their plasma glucose concentration 4 h after feeding than the W diet. The G diet had some short-term benefits in providing energy and assistance to the calves to recover from dehydration, as indicated by a decrease in serum osmolality. However, the G diet was clearly inferior to the M and W diets in providing sufficient energy to assist the calves in recovering from the effects of transport and fasting. During the 4-h after feeding, no adverse effects of offering the calves the M or W diets were observed. The benefits of the W diet in replacing energy and water deficits were similar to those of the M diet, but the M diet was better able to assist the calves in maintaining their blood glucose concentration 4 h after feeding than the W diet.
Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip ...fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians.
Ileostomies constitute 15% to 43% of readmissions after colorectal surgery, often due to dehydration and acute kidney injury. Prior institutional interventions decreased readmissions but not among ...patients who underwent new ileostomies.
To evaluate readmissions among patients who underwent new ileostomies after postoperative oral rehydration solution and standardized clinic visits.
Retrospective analysis of prospective database.
Enhanced recovery colorectal surgery service.
Patients who underwent new ileostomy before and after intervention.
Postoperative oral rehydration solution and postdischarge clinic visits with review of inputs/outputs, antimotility and appliance needs, and trained nurse reeducation 4 to 7 days after discharge, 30 days postoperatively, and every 1 to 2 weeks thereafter as needed.
Readmission rate due to dehydration/acute kidney injury (primary), emergency department visits, and readmission rates overall and for specific diagnoses. Analysis used univariate and weighted techniques.
A total of 312 patients (199 preintervention; 113 postintervention) were included, with a mean age of 59.0 years. Patients were predominantly White (94.9%) and evenly split between men and women. The most common diagnosis was diverticulitis (43.3%). The most common procedure was high anterior resection (38.8%), followed by low anterior resection (16.35%). Patient and procedure characteristics were well matched between groups. Multivariate analysis demonstrated that readmission rate due to dehydration/acute kidney injury significantly decreased between pre- and postintervention study groups (45.7% vs 16.5%, p = 0.039). Emergency department visits due to dehydration/acute kidney injury (12.0% vs 1.7%, p < 0.001) and readmissions from all causes (24.33% vs 10.6%, p = 0.005) also significantly decreased. Other complications were not significantly different between groups. Average stoma output 24 hours before (776 vs 625 mL, p = 0.005) and after (993 vs 890 mL, p = 0.025) discharge was significantly decreased in the postintervention group.
Retrospective single-center study.
An oral rehydration solution and frequent standardized postdischarge visits led by trained nursing staff decreased readmissions and emergency department visits among patients who underwent new ileostomies after colorectal surgery. See Video Abstract .
ANTECEDENTES:Las ileostomías constituyen del 15 al 43% de los reingresos después de la cirugía colorrectal, a menudo debido a la deshidratación y la lesión renal aguda. Las intervenciones institucionales previas redujeron los reingresos, pero no entre los pacientes con nuevas ileostomías.OBJETIVO:Evaluar los reingresos entre pacientes con nuevas ileostomías después del uso de solución de rehidratación oral postoperatoria y visitas clínicas estandarizadas.DISEÑO:Análisis retrospectivo de base de datos prospectiva.AJUSTES:Servicio de cirugía colorrectal de recuperación mejorada.PACIENTES:Pacientes con ileostomía nueva antes y después de la intervención.INTERVENCIÓN(ES):Solución de rehidratación oral posoperatoria y visitas clínicas posteriores al alta con revisión de entradas/salidas, antimotilidad y necesidades de aparatos, y reeducación de enfermeras capacitadas 4-7 días después del alta, 30 días después de la operación y cada 1-2 semanas después, según sea necesario.PRINCIPALES MEDIDAS DE RESULTADO:Tasa de readmisión debido a deshidratación/lesión renal aguda (primaria), tasa de urgencias y de readmisión en general y para diagnósticos específicos. El análisis utilizó técnicas univariadas y ponderadas.RESULTADOS:Se incluyeron un total de 312 pacientes (199 preintervención; 113 postintervención), con una edad media de 59,0 años. Los pacientes eran predominantemente blancos (94,9%) y se dividieron equitativamente entre hombres y mujeres. El diagnóstico más frecuente fue diverticulitis (43,3%). El procedimiento más común fue la resección anterior alta (38,8 %) seguida de la resección anterior baja (16,35 %). Las características del paciente y del procedimiento coincidieron bien entre los grupos. El análisis multivariante demostró que la tasa de reingreso debido a deshidratación/lesión renal aguda disminuyó significativamente entre los grupos de estudio antes y después de la intervención (45,7 % frente a 16,5 %, p = 0,039). Las visitas a urgencias por deshidratación/insuficiencia renal aguda (12,0 % frente a 1,7 %, p < 0,001) y los reingresos por todas las causas (24,33 % frente a 10,6 %, p = 0,005) también disminuyeron significativamente. Otras complicaciones no fueron significativamente diferentes entre los grupos. El gasto medio del estoma 24 horas antes (776 ml frente a 625 ml, p = 0,005) y después (993 ml frente a 890 ml, p = 0,025) del alta disminuyó significativamente en el grupo posterior a la intervención.LIMITACIONES:Estudio retrospectivo de centro único.CONCLUSIONES:Una solución de rehidratación oral y frecuentes visitas estandarizadas posteriores al alta dirigidas por personal de enfermería capacitado redujeron los reingresos y las visitas al servicio de urgencias entre los pacientes con nuevas ileostomías después de la cirugía colorrectal. ( Traducción-Dr. Yolanda Colorado ).
Vocal folds are a viscoelastic multilayered structure responsible for voice production. Vocal fold epithelial damage may weaken the protection of deeper layers of lamina propria and thyroarytenoid ...muscle and impair voice production. Systemic dehydration can adversely affect vocal function by creating suboptimal biomechanical conditions for vocal fold vibration. However, the molecular pathobiology of systemically dehydrated vocal folds is poorly understood. We used an in vivo rabbit model to investigate the complete gene expression profile of systemically dehydrated vocal folds. The RNA-Seq based transcriptome revealed 203 differentially expressed (DE) vocal fold genes due to systemic dehydration. Interestingly, function enrichment analysis showed downregulation of genes involved in cell adhesion, cell junction, inflammation, and upregulation of genes involved in cell proliferation. RT-qPCR validation was performed for a subset of DE genes and confirmed the downregulation of DSG1, CDH3, NECTIN1, SDC1, S100A9, SPINK5, ECM1, IL1A, and IL36A genes. In addition, the upregulation of the transcription factor NR4A3 gene involved in epithelial cell proliferation was validated. Taken together, these results suggest an alteration of the vocal fold epithelial barrier independent of inflammation, which could indicate a disruption and remodeling of the epithelial barrier integrity. This transcriptome provides a first global picture of the molecular changes in vocal fold tissue in response to systemic dehydration. The alterations observed at the transcriptional level help to understand the pathobiology of dehydration in voice function and highlight the benefits of hydration in voice therapy.
Dehydration, like many other aspects of an aging body, is often neglected by patients and physicians alike. Not only does it sometimes become difficult to clinically assess and identify dehydration ...in the elderly, but it also becomes difficult to attribute gross changes in functioning to something as simple as water depletion. This can be counterproductive to the overall health and even survival of elderly patients if diagnosis is delayed. We propose a comprehensive hydration stewardship program, with public health and clinical interventions, to prevent dehydration and its complications in vulnerable segments of society, such as the elderly. This short review summarizes current evidence available for the diagnosis and identification of dehydration in the elderly and shares preventive strategies to prevent its occurrence and complications.
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