Conscious Sedation with Inhaled 50% Nitrous Oxide/Oxygen Premix in Photodynamic Therapy Sessions for Vulvar Lichen Sclerosus Treatment

Photodynamic therapy has been described as an effective therapeutic option in selected cases of anogenital lichen sclerosus that are refractory to first-line treatments. However, procedure-related pain is a limiting factor in patient adherence to treatment. The authors report the case of a 75-year-old woman with highly symptomatic vulvar lichen sclerosus, successfully treated with photodynamic therapy. An inhaled 50% nitrous oxide/oxygen premix was administered during sessions, producing a pain-relieving, anxiolytic, and sedative effect without loss of consciousness. This ready-to-use gas mixture may be a well-tolerated and accepted alternative to classical anesthetics in Photodynamic therapy, facilitating patients' adherence to illumination of pain-prone areas.

Noninvasive assessment of diffusion hypoxia following administration of nitrous oxide-oxygen.

The phenomenon of diffusion hypoxia is commonly believed to occur unless nitrous oxide-oxygen inhalation sedation is followed by "washout" with 100% oxygen for 5 minutes upon termination of the flow of nitrous oxide. When systematically studied, however, this phenomenon generally appears to be unfounded. The present study evaluated the effect of breathing room air instead of 100% oxygen in healthy (ASA 1) human volunteers following administration of sedative concentrations of nitrous oxide. The occurrence of hypoxia was determined objectively, using pulse oximetry and a standardized psychomotor skills test (Trieger test). Diffusion hypoxia was not observed using these criteria.

Soil nitrous oxide emissions in long-term cover crops-based rotations under subtropical climate

It has been shown that cover crops can enhance soil nitrous oxide (N(2)O) emissions, but the magnitude of increase depends on the quantity and quality of the crop residues. Therefore, this study aimed to evaluate the effect of long-term (19 and 21 years) no-till maize crop rotations including grass [black oat (Avena strigosa Schreb)] and legume cover crops [vetch (Vigna sativa L), cowpea (Vigna unguiculata L. Walp), pigeon pea (Cajanus cajan L. Millsp.) and lablab (Dolichos lablab)] on annual soil N(2)O emissions in a subtropical Acrisol in Southern Brazil. Greater soil N(2)O emissions were observed in the first 45 days after the cover crop residue management in all crop rotations, varying from -20.2 +/- 1.9 to 163.9 +/- 24.3 mu g N m(-2) h(-1). Legume-based crop rotations had the largest cumulative emissions in this period, which were directly related to the quantity of N (r(2) = 0.60, p = 0.13)and inversely related to the lignin:N ratio(r(2) = 0.89,p = 0.01) of the cover crop residues. After this period, the mean fluxes were smaller and were closely related to the total soil N stocks (r(2) = 0.96, p = 0.002). The annual soil N(2)O emission represented 0.39-0.75% of the total N added by the legume cover crops. Management-control led soil variables such as mineral N (NO(3)(-) and NH(4)(+)) and dissolved organic C influenced more the N(2)O fluxes than environmental-related variables as water-filled pore space and air and soil temperature. Consequently, the synchronization between N mineralization and N uptake by plants seems to be the main challenge to reduce N(2)O emissions while maintaining the environmental and agronomic services provided by legume cover crops in agricultural systems. (C) 2009 Elsevier B.V. All rights reserved.

Role of oxygen in the nitrous oxide/carbon reaction

An investigation of the role of oxygen in the nitrous oxide/carbon reaction was carried out on various carbon samples (both graphitic and nongraphitic) over a range of temperatures and partial pressures. Previous work reported that oxygen strongly inhibited the nitrous oxide/carbon reaction. Large ratios of O-2/N2O were used in all previous work. In this work, the O-2/N2O ratio was kept below 1, and we found that oxygen did not inhibit the rate of the C + N2O reaction. Instead, the rate of the reaction in the presence of oxygen was essentially that predicted by the two independent reactions, nitrous oxide/carbon and oxygen/carbon, occurring simultaneously. A simple theoretical explanation is given for the observations, both past and present, on the basis of competitive chemisorption of nitrous oxide and oxygen on active sites.

Characterization of the activity of nitrous oxide reductase: biochemical, spectroscopic and mimetic approaches

Dissertação apresentada para a obtenção do Grau de Doutor em Química Sustentável pela Universidade Nova de Lisboa, Faculdade de Ciências e Tecnologia

Vulvar Lichen Sclerosus: Efficacy of Photodynamic Therapy Under Conscious Sedation with Inhaled 50% Nitrous Oxide and Oxygen Mixture

Anogenital lichen sclerosus is a chronic, inflammatory, mucocutaneous disorder of significant morbidity. Common symptoms include pruritus, pain, dysuria, and dyspareunia, frequently of difficult control. Photodynamic therapy (PDT) may be an effective therapeutic option in selected cases refractory to first--‐line treatment options. However, procedure--‐related pain is a limiting factor in patient adherence to treatment. Conscious sedation and analgesia with a ready--‐to--‐use gas mixture of nitrous oxide and oxygen is useful in short--‐term procedures. It provides a rapid, effective, and short--‐lived effect, without the need for anesthesiology support. A 75--‐year--‐old woman presented with a highly symptomatic, histologically confirmed vulvar lichen sclerosus, with at least 15 years of evolution. Pain, pruritus, and dysuria were intense and disabling. Treatment with ultrapotent topical corticosteroids proved to be ineffective despite patient compliance. She was then referred for PDT. A total of 3 sessions were performed, held at a mean interval of 9 weeks, and under the analgesic and sedative effect of nitrous oxide/oxygen gas. Response to treatment was evaluated through a daily, self--‐reported pain rating scale. Dysuria remitted completely after the first PDT session. An 80% reduction in pruritus and pain was observed after the third session, and has been sustained for the past six months without further need for topical corticotherapy. Treatment sessions were well tolerated and pain-- free, with no side effects to report. PDT appears to be effective in the symptomatic treatment of vulvar lichen sclerosus. To the authors’ knowledge this is the first case reporting the use of inhaled nitrous oxide/oxygen gas mixture during PDT performed in the genital area. Its analgesic and sedative effects may increase patients’ adherence to this painful procedure. Furthermore, given its safety, it can be easily managed in outpatient clinics by trained dermatologists.

The electron transfer complex between nitrous oxide reductase and its electron donors

J Biol Inorg Chem (2011) 16:1241–1254 DOI 10.1007/s00775-011-0812-9

The tetranuclear copper active site of nitrous oxide reductase: the CuZ center

J Biol Inorg Chem (2011) 16:183–194 DOI 10.1007/s00775-011-0753-3

A new CuZ active form in the catalytic reduction of N2O by nitrous oxide reductase from Pseudomonas nautica

J Biol Inorg Chem (2010) 15:967–976 DOI 10.1007/s00775-010-0658-6

Electron transfer complex between nitrous oxide reductase and cytochrome c552 from Pseudomonas nautica: kinetic, nuclear magnetic resonance, and docking studies

Biochemistry. 2008 Oct 14;47(41):10852-62. doi: 10.1021/bi801375q

Activation of N2O reduction by the fully reduced micro4-sulfide bridged tetranuclear Cu Z cluster in nitrous oxide reductase

J. Am. Chem. Soc., 2003, 125 (51), pp 15708–15709 DOI: 10.1021/ja038344n

The influence of use additives on nitrous oxide emission during swine slurry composting.

use of additives (Mg/P and nitrification inhibitor dicyandiamide - DCD), on nitrous oxide emission during swine slurry composting. The experiment was run in duplicate; the gas was monitored for 30 days in different treatments (control, DCD, Mg/P and DCD + Mg/P). Nitrous oxide emissions rate (mg of N2O-N.day-1) and the accumulated emissions were calculated to compare the treatments. Results has shown that emissions of N-N2O were reduced by approximately 70, 46 and 96% through the additions of DCD, MgCl2.6H2O + H3PO4 and both additives, respectively, compared to the control. Keywords Composting; swine slurry; additives; nitrous

Validation of an analytical method for nitrous oxide (N2O) laughing gas by headspace gas chromatography coupled to mass spectrometry (HS-GC-MS): Forensic application to a lethal intoxication.

Drug abuse is a widespread problem affecting both teenagers and adults. Nitrous oxide is becoming increasingly popular as an inhalation drug, causing harmful neurological and hematological effects. Some gas chromatography-mass spectrometry (GC-MS) methods for nitrous oxide measurement have been previously described. The main drawbacks of these methods include a lack of sensitivity for forensic applications; including an inability to quantitatively determine the concentration of gas present. The following study provides a validated method using HS-GC-MS which incorporates hydrogen sulfide as a suitable internal standard allowing the quantification of nitrous oxide. Upon analysis, sample and internal standard have similar retention times and are eluted quickly from the molecular sieve 5Å PLOT capillary column and the Porabond Q column therefore providing rapid data collection whilst preserving well defined peaks. After validation, the method has been applied to a real case of N2O intoxication indicating concentrations in a mono-intoxication.

Postharvest nitrous oxide emissions from a subtropical oxisol as influenced by summer crop residues and their management

Nitrous oxide (N2O) is the most important non-CO2 greenhouse gas and soil management systems should be evaluated for their N2O mitigation potential. This research evaluated a long-term (22 years) experiment testing the effect of soil management systems on N2O emissions in the postharvest period (autumn) from a subtropical Rhodic Hapludox at the research center FUNDACEP, in Cruz Alta, state of Rio Grande do Sul. Three treatments were evaluated, one under conventional tillage with soybean residues (CTsoybean) and two under no-tillage with soybean (NTsoybean) and maize residues (NTmaize). N2O emissions were measured eight times within 24 days (May 2007) using closed static chambers. Gas flows were obtained based on the relations between gas concentrations in the chamber at regular intervals (0, 15, 30, 45 min) analyzed by gas chromatography. After soybean harvest, accumulated N2O emissions in the period were approximately three times higher in the untilled soil (164 mg m-2 N) than under CT (51 mg m-2 N), with a short-lived N2O peak of 670 mg m-2 h-1 N. In contrast, soil N2O emissions in NT were lower after maize than after soybean, with a N2O peak of 127 g m-2 h-1 N. The multivariate analysis of N2O fluxes and soil variables, which were determined simultaneously with air sampling, demonstrated that the main driving variables of soil N2O emissions were soil microbial activity, temperature, water-filled pore space, and NO3- content. To replace soybean monoculture, crop rotation including maize must be considered as a strategy to decrease soil N2O emissions from NT soils in Southern Brazil in a Autumn.

Emission of nitrous oxide and carbon dioxide from semi-arid tropical soils in Chiapas México

The semi-arid region of Chiapas is dominated by N2 -fixing shrubs, e.g., Acacia angustissima. Urea-fertilized soil samples under maize were collected from areas covered and uncovered by A. angustissima in different seasons and N2O and CO2 emissions were monitored. The objective of this study was to determine the effects of urea and of the rainy and dry season on gas emissions from semi-arid soil under laboratory conditions. Urea and soil use had no effect on CO2 production. Nitrons oxide emission from soil was three times higher in the dry than in the rainy season, while urea fertilization doubled emissions. Emissions were twice as high from soil sampled under A. angustissima canopy than from arable land, but 1.2 lower than from soil sampled outside the canopy, and five times higher from soil incubated at 40 % of the water-holding capacity (WHC) than at soil moisture content, but 15 times lower than from soil incubated at 100 WHC. It was found that the soil sampling time and water content had a significant effect on N2O emissions, while N fertilizer and sampling location were less influent.