Detection of renal dysfunction during and after anaesthesia and surgery - evaluation of the influence of inorganic fluoride, ketorolac and clonidine

Drugs and surgical techniques may have harmful renal effects during the perioperative period. Traditional biomarkers are often insensitive to minor renal changes, but novel biomarkers may more accurately detect disturbances in glomerular and tubular function and integrity. The purpose of this study was first, to evaluate the renal effects of ketorolac and clonidine during inhalation anesthesia with sevoflurane and isoflurane, and secondly, to evaluate the effect of tobacco smoking on the production of inorganic fluoride (F-) following enflurane and sevoflurane anesthesia as well as to determine the effect of F- on renal function and cellular integrity in surgical patients. A total of 143 patients undergoing either conventional (n = 75) or endoscopic (n = 68) inpatient surgery were enrolled in four studies. The ketorolac and clonidine studies were prospective, randomized, placebo controlled and double-blinded, while the cigarette smoking studies were prospective cohort studies with two parallel groups. As a sign of proximal tubular deterioration, a similar transient increase in urine N-acetyl-beta-D-glucosaminidase/creatinine (U-NAG/crea) was noted in both the ketorolac group and in the controls (baseline vs. at two hours of anesthesia, p = 0.015) with a 3.3 minimum alveolar concentration hour sevoflurane anesthesia. Uncorrelated U-NAG increased above the maximum concentration measured from healthy volunteers (6.1 units/l) in 5/15 patients with ketorolac and in none of the controls (p = 0.042). As a sign of proximal tubular deterioration, U-glutathione transferase-alpha/crea (U-GST-alpha/crea) increased in both groups at two hours after anesthesia but a more significant increase was noted in the patients with ketorolac. U-GST-alpha/crea increased above the maximum ratio measured from healthy volunteers in 7/15 patients with ketorolac and in 3/15 controls. Clonidine diminished the activation of the renin-angiotensin aldosterone system during pneumoperitoneum; urine output was better preserved in the patients treated with clonidine (1/15 patients developed oliguria) than in the controls (8/15 developed oliguria (p=0.005)). Most patients with pneumoperitoneum and isoflurane anesthesia developed a transient proximal tubular deterioration, as U-NAG increased above 6.1 units/L in 11/15 patients with clonidine and in 7/15 controls. In the patients receiving clonidine treatment, the median of U-NAG/crea was higher than in the controls at 60 minutes of pneumoperitoneum (p = 0.01), suggesting that clonidine seems to worsen proximal tubular deterioration. Smoking induced the metabolism of enflurane, but the renal function remained intact in both the smokers and the non-smokers with enflurane anesthesia. On the contrary, smoking did not induce sevoflurane metabolism, but glomerular function decreased in 4/25 non-smokers and in 7/25 smokers with sevoflurane anesthesia. All five patients with S-F- ≥ 40 micromol/L, but only 6/45 with S-F- less than 40 micromol/L (p = 0.001), developed a S-tumor associated trypsin inhibitor concentration above 3 nmol/L as a sign of glomerular dysfunction. As a sign of proximal tubulus deterioration, U-beta 2-microglobulin increased in 2/5 patients with S-F- over 40 micromol/L compared to 2/45 patients with the highest S-F- less than 40 micromol/L (p = 0.005). To conclude, sevoflurane anesthesia may cause a transient proximal tubular deterioration which may be worsened by a co-administration of ketorolac. Clonidine premedication prevents the activation of the renin-angiotensin aldosterone system and preserves normal urine output, but may be harmful for proximal tubules during pneumoperitoneum. Smoking induces the metabolism of enflurane but not that of sevoflurane. Serum F- of 40 micromol/L or higher may induce glomerular dysfunction and proximal tubulus deterioration in patients with sevoflurane anesthesia. The novel renal biomarkers warrant further studies in order to establish reference values for surgical patients having inhalation anesthesia.

Detection of clinical mastitis with the help of a thermal camera

Increasing dairy farm size and increase in automation in livestock production require that new methods are used to monitor animal health. In this study, a thermal camera was tested for its capacity to detect clinical mastitis. Mastitis was experimentally induced in 6 cows with 10 mu g of Escherichia coli lipopolysaccharide (LPS). The LPS was infused into the left forequarter of each cow, and the right forequarters served as controls. Clinical examination for systemic and local signs and sampling for indicators of inflammation in milk were carried out before morning and evening milking throughout the 5-d experimental period and more frequently on the challenge day. Thermal images of experimental and control quarters were taken at each sampling time from lateral and medial angles. The first signs of clinical mastitis were noted in all cows 2 h postchallenge and included changes in general appearance of the cows and local clinical signs in the affected udder quarter. Rectal temperature, milk somatic cell count, and electrical conductivity were increased 4 h postchallenge and milk N-acetyl-beta-D-glucosaminidase activity 8 h postchallenge. The thermal camera was successful in detecting the 1 to 1.5 degrees C temperature change on udder skin associated with clinical mastitis in all cows because temperature of the udder skin of the experimental and control quarters increased in line with the rectal temperature. Yet, local signs on the udder were seen before the rise in udder skin and body temperature. The udder represents a sensitive site for detection of any febrile disease using a noninvasive method. A thermal camera mounted in a milking or feeding parlor could detect temperature changes associated with clinical mastitis or other diseases in a dairy herd.

Contrast-enhanced ultrasound of abdominal organs in cats

The primary aim of this thesis was the evaluation of the perfusion of normal organs in cats using contrast-enhanced ultrasound (CEUS), to serve as a reference for later clinical studies. Little is known of the use of CEUS in cats, especially regarding its safety and the effects of anesthesia on the procedure, thus, secondary aims here were to validate the quantitative analyzing method, to investigate the biological effects of CEUS on feline kidneys, and to assess the effect of anesthesia on splenic perfusion in cats undergoing CEUS. -- The studies were conducted on healthy, young, purpose-bred cats. CEUS of the liver, left kidney, spleen, pancreas, small intestine, and mesenteric lymph nodes was performed to characterize the normal perfusion of these organs on ten anesthetized, male cats. To validate the quantification method, the effects of placement and size of the region of interest (ROI) on perfusion parameters were investigated using CEUS: Three separate sets of ROIs were placed in the kidney cortex, varying in location, size, or depth. The biological effects of CEUS on feline kidneys were estimated by measuring urinary enzymatic activities, analyzing urinary specific gravity, pH, protein, creatinine, albumin, and sediment, and measuring plasma urea and creatinine concentrations before and after CEUS. Finally, the impact of anesthesia on contrast enhancement of the spleen was investigated by imaging cats with CEUS first awake and later under anesthesia on separate days. -- Typical perfusion patterns were found for each of the studied organs. The liver had a gradual and more heterogeneous perfusion pattern due to its dual blood flow and close proximity to the diaphragm. An obvious and statistically significant difference emerged in the perfusion between the kidney cortex and medulla. Enhancement in the spleen was very heterogeneous at the beginning of imaging, indicating focal dissimilarities in perfusion. No significant differences emerged in the perfusion parameters between the pancreas, small intestine, and mesenteric lymph nodes. -- The ROI placement and size were found to have an influence on the quantitative measurements of CEUS. Increasing the depth or the size of the ROI decreased the peak intensity value significantly, suggesting that where and how the ROI is placed does matter in quantitative analyses. --- A significant increase occurred in the urinary N-acetyl-β-D-glucosaminidase (NAG) to creatinine ratio after CEUS. No changes were noted in the serum biochemistry profile after CEUS, with the exception of a small decrease in blood urea concentration. The magnitude of the rise in the NAG/creatinine ratio was, however, less than the circadian variation reported earlier in healthy cats. Thus, the changes observed in the laboratory values after CEUS of the left kidney did not indicate any detrimental effects in kidneys. Heterogeneity of the spleen was observed to be less and time of first contrast appearance earlier in nonanesthetized cats than in anesthetized ones, suggesting that anesthesia increases heterogeneity of the feline spleen in CEUS. ---- In conclusion, the results suggest that CEUS can be used also in feline veterinary patients as an additional diagnostics aid. The perfusion patterns found in the imaged organs were typical and similar to those seen earlier in other species, with the exception of the heterogeneous perfusion pattern in the cat spleen. Differences in the perfusion between organs corresponded with physiology. Based on the results, estimation of focal perfusion defects of the spleen in cats should be performed with caution and after the disappearance of the initial heterogeneity, especially in anesthetized or sedated cats. Finally, these results indicate that CEUS can be used safely to analyze kidney perfusion also in cats. Future clinical studies are needed to evaluate the full potential of CEUS in feline medicine as a tool for diagnosing lesions in various organ systems.

Anthraquinones from the Fungus Dermocybe sanguinea as Textile Dyes

This study is based on the multidiciplinary approach of using natural colorants as textile dyes. The author was interested in both the historical and traditional aspects of natural dyeing as well as the modern industrial applications of the pure natural compounds. In the study, the anthraquinone compounds were isolated as aglycones from the ectomycorrhizal fungus Dermocybe sanguinea. The endogenous beta-glucosidase of the fungus was used to catalyse the hydrolysis of the O-glycosyl linkage in emodin- and dermocybin-1-beta-D-glucopyranosides. The method, in which 10.45 kg of fresh fungi was starting material, yielded two fractions: 56.0 g of Fraction 1 (94% of the total amount of pigment,) consisting almost exclusively of the main pigments emodin and dermocybin, and 3.3 g of Fraction 2 (6%) consisting mainly of the anthraquinone carboxylic acids. The anthraquinone compounds in Fractions 1 and 2 were separated by one- and two-dimensional thin-layer-chromatography (TLC) using silica plates. 1D TLC showed that neither an acidic nor a basic solvent system alone separated completely all the anthraquinones isolated from D. sanguinea, in spite of the variation of the rations of the solvent components in the systems. Thus, a new 2D TLC technique was developed, applying n-pentanol-pyridine-methanol (6:4:3, v/v/v) and toluene-ethyl acetate-ethanol-formic acid (10:8:1:2, v/v/v/v) as eluents. Fifteen different anthraquinone derivatives were completely separated from one another. Emodin, physcion, endocrocin, dermolutein, dermorubin, 5-chlorodermorubin, emodin-1-beta-D-glucopyranoside, dermocybin-1-beta-D-glucopyranoside and dermocybin, and five new compounds, not earlier identified in D. sanguinea, 7-chloroemodin, 5,7-dichloroemodin, 5,7-dichloroendocrocin, 4-hydroxyaustrocorticone and austrocorticone, were separated and identified on the basis of their Rf-values, UV/Vis spectra and mass spectra. One substance remained unidentified, because of its very low concentration. The anthraquinones in Fractions 1 and 2 were preparatively separeted by liquid-liquid partition, with isopropylmethyl ketone and aqueous phosphate buffer as the solvent system. Advantage was taken of the principle of stepwise pH-gradient elution. The multiple liquid-liquid partition (MLLP) offered an excellent method for the preparative separation of compounds, which contain acidic groups such as the phenolic OH and COOH groups. Due to their strong aggregation properties, these compounds are, without derivatization, very difficult to separate on a preparative scale by chromatographic methods. By the MLLP method remarkable separations were achieved for the components in each mixture. Emodin and dermocybin were both obtained from Fraction 1 in a purity of at least 99%. Pure emodin and dermocybin were applied as mordant dyes to wool and polyamide and as disperse dyes to polyester and polyamide, using the high temperature (HT) technique. A mixture of dermorubin and 5-chlorodermorubin was applied as an acid dye to wool. In these experiments, synthetic dyes were used as references. Experiments were also performed using water extract of the air-dried fungi as dye liquor for wool and silk. The main colouring compounds in the crude water extract were emodin and dermocybin, which indicated that the O-glycosyl linkages in emodin- and dermocybin-1-beta-D-glucopyranosides were broken by the beta-glucosidase enzyme. Apparently, the hydrolysis occurred during the drying of the fungi and during the soaking of the dried fruit bodies overnight when preparing the dyebath. The colour of each dyed material was investigated in terms of the CIELAB L*, a* and b* values, and the colour fastness to light, washing and rubbing was tested according to the ISO standards. In the mordant dyeing experiments, emodin dyed wool and polyamide yellow and red, depending on the pH of the dyebath. Dermocybin gave purple and violet colours. The colour fastness of the mordant-dyed fabrics varied from good to moderate. The fastness properties of the natural anthraquinone carboxylic acids on wool were good, indicating the strength of the ionic bonds between the COO- groups of the dyes and the NH3+ groups of the fibres. In the disperse dyeing experiments, emodin dyed polyester bright yellow and dermocybin bright reddish-orange, and the fabrics showed excellent colour fastness. In contrast, emodin and dermocybin successfully dyed polyamide brownish-orange and wine-red, respectively, but with only moderate fastness. In industrial dyeing processes, natural anthraquinone aglycone mixtures dyed wool and silk well even at low concentrations of mordants, i.e. with 10% of the weight of the fibre (owf) of KAl(SO4)2 and 1 or 0.5% owf of other mordants. This study showed that purified natural anthraquinone compounds can produce bright hues with good colour-fastness properties in different textile materials. Natural anthraquinones have a significant potential for new dyeing techniques and will provide useful alternatives to synthetic dyes.

N-acetyl-β-D-glucosaminidaasi-entsyymiaktiivisuus normaalimaidossa sekä utaretulehdusta sairastavien lypsylehmien maidossa.

N-acetyl-β-D-glucosaminidaasi (NAGaasi) on glykosidaaseihin kuuluva, solujen lysosomeissa esiintyvä entsyymi, jota vapautuu maitoon utaretulehduksen aikana vaurioituneista utareen epiteelisoluista, neutrofiileistä ja makrofageista. NAGaasientsyymiaktiivisuuden on useissa tutkimuksissa havaittu korreloivan utareen tulehdustilan ja maidon soluluvun (SCC) kanssa ja sitä on ehdotettu käytettäväksi utareen epiteelisolutuhon mittaamiseen yksinään tai yhdistettynä SCC:n määritykseen. Koska saostuminen ei häiritse NAGaasi-entsyymiaktiivisuuden mittausta maidosta, entsyymiaktiivisuus ei muutu maitoa säilytettäessä ja entsyymin mittaaminen on melko yksinkertaista ja nopeaa, menetelmä vaikuttaisi sopivan hyvin seulontatestiksi piileville utaretulehduksille. NAGaasin käyttö on toistaiseksi rajoittunut tutkimuskäyttöön. Sen hyödyntämistä vaikeuttaa se, että terveille lehmille eri tutkimuksissa määritetyissä NAGaasi-entsyymiaktiivisuuden viitearvoissa on suurta vaihtelua. NAGaasi-entsyymiaktiivisuus maidossa on useiden tutkimusten mukaan korkeampi silloin, kun tulehduksen on aiheuttanut jokin merkittävä patogeeni kuin silloin, kun tulehduksen taustalla on vähäpätöinen patogeeni. Lypsykauden vaiheen on havaittu vaikuttavan maidon NAGaasi-entsyymiaktiivisuuteen siten, että aktiivisuudet ovat korkeampia heti poikimisen jälkeen ja lypsykauden lopulla. On myös havaittu, että normaalimaidossa NAGaasi-entsyymiaktiivisuus on hieman korkeampi loppumaidossa kuin alkumaidossa. Poikimakerran vaikutuksista NAGaasi-entsyymiaktiivisuuteen on ristiriitaisia tutkimustuloksia. Tämän tutkimuksen tavoitteena oli määrittää NAGaasi-entsyymiaktiivisuuden viitearvot terveen sekä utaretulehdusta sairastavan lypsylehmän maidossa, sekä selvittää tulehduksen voimakkuuden, aiheuttajapatogeenin, poikimakerran ja lypsykauden vaiheen vaikutusta kyseisen entsyymin aktiivisuuteen maidossa. Tutkimusaineistossa oli mukana kaikkiaan 838 vuosina 2000–2010 otettua maitonäytettä 62 eri lypsykarjatilalta Suomesta ja Virosta. Normaalimaidon NAGaasi-entsyymiaktiivisuuden viitearvot määritettiin yhdeksältä suomalaiselta lypsykarjatilalta kerätyistä 196 maitonäytteestä, jotka täyttivät asettamamme normaalimaidon kriteerit. Normaalimaidon kriteerit olivat seuraavat: SCC < 100 000, lehmällä ei ole utaretulehduksen oireita, poikimisesta on kulunut aikaa yli 30 vuorokautta ja edellisestä lypsystä yli 6 tuntia. NAGaasi-entsyymiaktiivisuus mitattiin modifioidulla Mattilan menetelmällä (Mattila 1985) vakioiduissa olosuhteissa. Aineisto analysoitiin käyttäen Stata Intercooler tilasto-ohjelman versiota 11.0 (Stata Corporation, Texas, USA). Maidon NAGaasientsyymiaktiivisuuteen terveessä neljänneksessä vaikuttavia tekijöitä tutkittiin lineaarisella sekamallilla, jossa sekoittavana tekijänä oli tila. SCC:n ja NAGaasi-entsyymiaktiivisuuden korrelaatiota arvioitiin terveillä lehmillä, piilevää utaretulehdusta sairastaneilla lehmillä ja koko aineistossa. Korrelaatiot laskettiin Pearsonin korrelaatiokertoimella. Tilastollisesti merkitsevänä raja-arvona kaikissa analyyseissä pidettiin p < 0.05. Normaalimaidon NAGaasi-entsyymiaktiivisuuden viitearvoiksi lehmillä, joilla poikimisesta oli kulunut yli 30 vrk, saatiin 0,09–1,04 pmol/min/μl maitoa. Verrattuna normaalimaidon NAGaasi-entsyymiaktiivisuuksien keskiarvoon (0,56) ja piilevää utaretulehdusta sairastaneiden lehmien NAGaasi-entsyymiaktiivisuuksien keskiarvoon (2,49), kliinistä utaretulehdusta sairastavien lehmien maidon NAGaasi-entsyymiaktiivisuus oli keskimäärin selvästi korkeampi (16,65). Keskiarvoissa oli selvä ero paikallisoireisten (12,24) ja yleisoireisten (17,74) lehmien välillä. Terveiden neljännesten maitonäytteistä määritetyn NAGaasi-entsyymiaktiivisuuden ja SCC:n välillä ei havaittu korrelaatiota. Piilevässä utaretulehduksessa havaittiin positiivinen korrelaatio (0,74) maidon NAGaasientsyymiaktiivisuuden ja SCC:n välillä. NAGaasi-entsyymiaktiivisuuteen vaikuttivat tilastollisesti merkitsevästi SCC, poikimisesta kulunut aika ja poikimakerta. Eri patogeeniryhmien osalta havaitsimme, että neljänneksissä, joista eristettiin vähäpätöinen patogeeni, NAGaasi-entsyymiaktiivisuus oli selvästi matalampi kuin neljänneksissä, joista eristettiin merkittävä patogeeni. NAGaasi-entsyymiaktiivisuuden keskiarvoksi vähäpätöisille patogeeneille (KNS, koryneformi) saatiin 2,82 ja merkittäville patogeeneille (S. aureus, Str. uberis, Str, agalactiae, Str. dysgalactiae, E.coli) 16,87.