-
The Veterinary Clinics of North... Mar 1989Mixed acid-base disturbances are combinations of two or more primary acid-base disturbances. Mixed acid-base disturbances may be suspected on the basis of findings... (Review)
Review
Mixed acid-base disturbances are combinations of two or more primary acid-base disturbances. Mixed acid-base disturbances may be suspected on the basis of findings obtained from the medical history, physical examination, serum electrolytes and chemistries, and anion gap. The history, physical examination, and serum biochemical profile may reveal disease processes commonly associated with acid-base disturbances. Changes in serum total CO2, serum potassium and chloride concentrations, or increased anion gap may provide clues to the existence of acid-base disorders. Blood gas analysis is usually required to confirm mixed acid-base disorders. To identify mixed acid-base disorders, blood gas analysis is used to identify primary acid-base disturbance and determine if an appropriate compensatory response has developed. Inappropriate compensatory responses (inadequate or excessive) are evidence of a mixed respiratory and metabolic disorder. The anion gap is also of value in detecting mixed acid-base disturbances. In high anion gap metabolic acidosis, the change in the anion gap should approximate the change in serum bicarbonate. Absence of this relationship should prompt consideration of a mixed metabolic acid-base disorder. Finding an elevated anion gap, regardless of serum bicarbonate concentration, suggests metabolic acidosis. In some instances, elevated anion gap is the only evidence of metabolic acidosis. In patients with hyperchloremic metabolic acidosis, increases in the serum chloride concentration should approximate the reduction in the serum bicarbonate concentration. Significant alterations from this relationship also indicate that a mixed metabolic disorder may be present. In treatment of mixed acid-base disorders, careful consideration should be given to the potential impact of therapeutically altering one acid-base disorder without correcting others.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Acidosis; Acidosis, Respiratory; Alkalosis; Alkalosis, Respiratory; Animals; Blood Gas Analysis; Carbon Dioxide; Cat Diseases; Cats; Dog Diseases; Dogs; Electrolytes; Hydrogen-Ion Concentration
PubMed: 2494782
DOI: 10.1016/s0195-5616(89)50032-9 -
Journal of Neurological Surgery. Part... Feb 2018Lateral skull base pathology is rare in children. Awareness of the potential for lateral skull base lesions in children is imperative for timely identification and... (Review)
Review
Lateral skull base pathology is rare in children. Awareness of the potential for lateral skull base lesions in children is imperative for timely identification and appropriate management. Some of the common presentations and pathologies shall be presented, as well as a variety of approaches that may be utilized to access the lateral skull base in the pediatric patient. Although the lateral skull base approaches utilized in adults may also be considered for management of pediatric lesions, some special considerations given the small developing anatomy need to be kept in mind.
PubMed: 29404241
DOI: 10.1055/s-0038-1624572 -
Wiener Klinische Wochenschrift 2007
Comparative Study Review
Topics: Acid-Base Imbalance; Acidosis; Acidosis, Lactic; Acidosis, Renal Tubular; Acidosis, Respiratory; Algorithms; Alkalosis; Critical Care; Diagnosis, Differential; Humans; Hydrogen-Ion Concentration
PubMed: 17939279
DOI: 10.1007/s11812-007-0020-2 -
Critical Reviews in Clinical Laboratory... May 2019Acid-base homeostasis is fundamental for life. The body is exceptionally sensitive to changes in pH, and as a result, potent mechanisms exist to regulate the body's... (Review)
Review
Acid-base homeostasis is fundamental for life. The body is exceptionally sensitive to changes in pH, and as a result, potent mechanisms exist to regulate the body's acid-base balance to maintain it in a very narrow range. Accurate and timely interpretation of an acid-base disorder can be lifesaving but establishing a correct diagnosis may be challenging. The underlying cause of the acid-base disorder is generally responsible for a patient's signs and symptoms, but laboratory results and their integration into the clinical picture is crucial. Important acid-base parameters are often available within minutes in the acute hospital care setting, and with basic knowledge it should be easy to establish the diagnosis with a stepwise approach. Unfortunately, many caveats exist, beginning in the pre-analytical phase. In the post-analytical phase, studies on the arterial reference pH are scarce and therefore many different reference values are used in the literature without any solid evidence. The prediction models that are currently used to assess the acid-base status are approximations that are mostly based on older studies with several limitations. The two most commonly used methods are the physiological method and the base excess method, both easy to use. The secondary response equations in the base excess method are the most convenient. Evaluation of acid-base disorders should always include the assessment of electrolytes and the anion gap. A major limitation of the current acid-base laboratory tests available is the lack of rapid point-of-care laboratory tests to diagnose intoxications with toxic alcohols. These intoxications can be fatal if not recognized and treated within minutes to hours. The surrogate use of the osmolal gap is often an inadequate substitute in this respect. This article reviews the role of the clinical laboratory to evaluate acid-base disorders.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Adult; Aged; Blood Chemical Analysis; Electrolytes; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Young Adult
PubMed: 30917291
DOI: 10.1080/10408363.2019.1568965 -
Seminars in Plastic Surgery Nov 2017Traumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with... (Review)
Review
Traumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.
PubMed: 29075156
DOI: 10.1055/s-0037-1607275 -
Kidney International Dec 2009Effective management of acid-base disorders depends on accurate diagnosis. Three distinct approaches are currently used in assessing acid-base disorders: the... (Comparative Study)
Comparative Study Review
Effective management of acid-base disorders depends on accurate diagnosis. Three distinct approaches are currently used in assessing acid-base disorders: the physiological approach, the base-excess approach, and the physicochemical approach. There are considerable differences among the three approaches. In this review, we first describe the conceptual framework of each approach, and comment on its attributes and drawbacks. We then highlight the application of each approach to patient care. We conclude with a brief synthesis and our recommendations for choosing an approach.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Adult; Female; Humans; Male; Middle Aged; Models, Biological
PubMed: 19812535
DOI: 10.1038/ki.2009.359 -
Sheng Wu Gong Cheng Xue Bao = Chinese... Sep 2021In recent years, the genome editing technologies based on the clustered regularly interspaced short palindromic repeats/CRISPR-associated protein (CRISPR/Cas) have... (Review)
Review
In recent years, the genome editing technologies based on the clustered regularly interspaced short palindromic repeats/CRISPR-associated protein (CRISPR/Cas) have developed rapidly. The system can use homologous directed recombination (HDR) to achieve precise editing that it medicated, but the efficiency is extremely low, which limits its application in agriculture and biomedical fields. As an emerging genome editing technology, the CRISPR/Cas-mediated DNA base editing technologies can achieve targeted mutations of bases without generating double-strand breaks, and has higher editing efficiency and specificity compared with CRISPR/Cas-mediated HDR editing. At present, cytidine base editors (CBEs) that can mutate C to T, adenine base editors (ABEs) that can mutate A to G, and prime editors (PEs) that enable arbitrary base conversion and precise insertion and deletion of small fragments, have been developed. In addition, glycosylase base editors (GBEs) capable of transitioning from C to G and double base editors capable of editing both A and C simultaneously, have been developed. This review summarizes the development, advances, advantages and limitations of several DNA base editors. The successful applications of DNA base editing technology in biomedicine and agriculture, together with the prospects for further optimization and selection of DNA base editors, are discussed.
Topics: Agriculture; CRISPR-Cas Systems; DNA; Gene Editing; Technology
PubMed: 34622618
DOI: 10.13345/j.cjb.200693 -
World Neurosurgery May 2022Surgery is the first-line therapy for most benign and malignant skull base tumors. Extent of resection (EOR) is a metric commonly used for preoperative surgical planning... (Review)
Review
Surgery is the first-line therapy for most benign and malignant skull base tumors. Extent of resection (EOR) is a metric commonly used for preoperative surgical planning and to predict risk of postoperative tumor recurrence. Therefore, understanding the evidence on EOR in skull base neurosurgery is essential to providing optimal care for each patient. Several studies from the skull base neurosurgery literature have presented investigations of various topics related to EOR, including 1) preoperative EOR scoring systems, 2) intraoperative EOR scoring systems, 3) EOR and tumor recurrence, and 4) EOR and functional outcomes. We propose that future investigations should focus on the following elements to improve EOR research in skull base neurosurgery: 1) multi-institutional collaboratives with treatment propensity matching; 2) expert consensus and mixed-methods study design; and 3) predictive analytics/machine learning. We believe that these methods offer several advantages that have been described in the literature and that they address limitations of previous studies. The aim of this review was to inform future study design and improve the overall quality of subsequent investigations on EOR in skull base neurosurgery.
Topics: Humans; Neoplasm Recurrence, Local; Neurosurgery; Neurosurgical Procedures; Skull Base; Skull Base Neoplasms
PubMed: 35505559
DOI: 10.1016/j.wneu.2021.10.184 -
ChemistryOpen May 2024Base-filling, i. e., post-synthetic furnishing of an oligonucleotide scaffold with base moieties or their analogues, is an interesting alternative to the conventional...
Base-filling, i. e., post-synthetic furnishing of an oligonucleotide scaffold with base moieties or their analogues, is an interesting alternative to the conventional approach of sequential coupling of building blocks (modified or otherwise). Reversible attachment of the base moieties is particularly attractive as it allows the use of dynamic combinatorial chemistry and usually leads to higher fidelity. This concept article summarizes the various backbones and coupling reactions used for base-filling over the past fifteen years, discusses the impact of base stacking and pairing on efficiency and fidelity and highlights potential and realized applications.
PubMed: 38709096
DOI: 10.1002/open.202400088 -
Otolaryngologic Clinics of North America Apr 2017The transnasal endoscopic resection of ventral skull base lesions represents a safe and effective method for the surgical management of sinonasal and ventral skull base... (Review)
Review
The transnasal endoscopic resection of ventral skull base lesions represents a safe and effective method for the surgical management of sinonasal and ventral skull base malignancies in carefully selected cases. The goal of surgery is complete removal of all tumor with negative resection margins while maintaining the key oncological principles. Careful selection of cases along with the presence of an experienced surgeon and a fully involved multidisciplinary skull base team trained in the management of ventral skull base neoplasm are essential for excellent outcomes.
Topics: Endoscopy; Humans; Magnetic Resonance Imaging; Paranasal Sinus Neoplasms; Paranasal Sinuses; Skull Base; Skull Base Neoplasms; Tomography, X-Ray Computed
PubMed: 28162240
DOI: 10.1016/j.otc.2016.12.005