DHEA as marker of good surgical homeostasis

2017

The aim of this review is to clarify the clinical significance of DHEA/DHEAS based on current medical findings. The objectives raised are as follows. 1. To describe an overview of synthesis and metabolism of DHEA/ DHEA-S in humans. 2. To describe mechanism of action, 3. To describe clinical significance of DHEA/ DHEA-S in various organs and/ or pathologies. 4. To describe role of DHEA/DHEA-S in treatment. 5. To make an inventory of relevant case reports involving DHEA/ DHEA-S from year 2000 onwards. Methods: Search of PubMed using keywords such as "DHEA", "DHEA-S", "Dehydroepiandrosterone"and "Dehydroepiandrosterone-Sulfate" was conducted and 40 articles were selected based on their relevance to the topics. In addition to this 40 case reports that describe DHEA was identified and were tabulated. Results: Out of the 40 case reports, 7 described the use of DHEA/DHEAS as a treatment and 2 of these reports showed negative effects. 33 case reports described laboratory values of DHEA (some of them high and some of the undetectable or low). 12 instances of adrenal tumors were noticed. Conclusions: Clinical significance is varied in that DHEA has stimulatory effects on bone mineral density, protective role in cardiovascular diseases [16]. Positively affects memory, mood, energy and indirect physical activity [8]. Raised levels of DHEAS are found in plasma of patients with adrenal tumors or with congenital adrenal hyperplasia (CAH). In adrenal insufficiency or panhypopituitarism DHEAS levels may usually be undetectable or low [5]. DHEA therapy is promising in patients with impaired well-being, mood or sexuality. In elderly population, DHEA use shows favorable outcomes in body composition, skin hydration increase bone mass density. DHEA use is advocated in replacement of pathophysiological defined DHEA deficiency, such as in adrenal insufficiency or glucocorticoid treated patients. Although every aspect of DHEA physiological role is yet to found, certain positive effects have been established and the impact it's causing is promising.

Journal of Steroid Biochemistry and Molecular Biology, 2008

Healthy postmenopausal women aged 60-65 years (n = 150) were randomized to receive twice daily application on the skin of 3 g of a 0.3% dehydroepiandrosterone (DHEA) or placebo emulsion for 12 months. Serum DHEA and eleven of its metabolites were measured at screening and on day 1, as well as at 1, 3, 6, 9 and 12 months to study long-term metabolism. While serum DHEA and androst-5-ene-3␤, 17␤-diol (5-diol) increased by 203% and 178%, respectively, on average, during the 12-month period, the sum of concentrations of the metabolites of androgens, namely androsterone glucuronide (ADT-G), androstane-3␣,17␤-diol-3G and -17G increased by only 71% while usually non statistically significant changes of 30%, 17% and 20% were observed for estrone (E 1 ), estradiol (E 2 ) and E 1 sulfate (E 1 -S), respectively.

2017

A surgical operation triggers systemic homeostatic responses in a way that varies but rarely takes place out of range. When it does, an allostatic process is defining the route to survival. When a major operation takes place, with long duration or/and severe violation of organs physiology, brain, liver and adrenals react with scientifically documented patterns described by the theories of organ axes. According to the classic terminology, allostasis is described mostly as a cumulative phenomenon and not as a sudden shock, so it is more close to this terminology that surgical operations might play a crucial role in allostatic chronic conditions or major post operation disabilities. Surgical diseases that could represent allostatic phenomena are the inflammatory bowel diseases, morbid obesity and before and after bariatric operation, post injury conditions ( multi-trauma cases), patients before and after transplantation, and patients with stomas or long standing artificial enteral nutr...

Blood Coagulation & Fibrinolysis, 2009

Annals of the New York Academy of Sciences, 1995

The actions of dehydroepiandroserone (DHEA) have been studied at three different levels: ( I ) physiologic, ( 2 ) pharmacologic, and (3) dietary or suprapharmacologic.

Journal of Steroid Biochemistry and Molecular Biology, 2007

The marked decline in serum dehydroepiandrosterone (DHEA) with age is believed to play a role in health problems associated with aging, these health issues being potentially preventable or reversible by the exogenous administration of DHEA.

Shock, 2006

A separation method is presented that yields liquid fractions with sample constituents conserved in their native states. Size exclusion, anion exchange, and lectin chromatography are used for the first, second, and third separation dimension, respectively. 96 parallel chromatographic micro-columns are used with micro-plates and the automated CyBio AG analysis platform so that each Separation step may be applied to all fractions of the foregoing one. Up to 100 mg of sample protein can be separated into up to 6000 fractions. Routinely, two samples are separated within 14 h simultaneously into 3360 2D-fractions each. 1D-and 2D recovery is 96.2 T 7.5% (n = 178) and 103.2 T 16.1% (n = 26), respectively. The protein concentrations obtained are highly reproducible. Within 2-D fractions of six runs, CV was 12.9% T 7.7% (mean + SD), 9.5% T 3.3%, and 6.1% T 2.0% in the range 0.35 to 0.5, 0.7 to 1.0, and 1.4 to 2 mg protein/ml, respectively. Spectrophotometric, enzymatic, and immunological analyses as well as MALDI-MS and ESI-MS/MS can be applied to the chromatographic fractions. More than 1000 proteins were identified with this method in healthy human serum (www.db-thuerinqen.de/servlets/ DocumentServlet?id=4054). Along with protein entities, various functional protein complexes (interactomes), proteolytic fragments, glycosylated and glycated proteins, and non-protein constituents were evidenced. Firstly, 2D fraction loci are considered to contain biomarkers, if their UV-absorbance correlate clearly and reproducibly with the clinical findings. Secondly, Proteins exhibiting altered concentrations in such patient-serum fractions are identified by a robust semi-quantitative mass spectrometric approach. The method was evaluated by confirming known protein changes in sera of patients with renal failure and severe inflammatory diseases. Lists of new biomarker candidates obtained are still under proof. 4 COMBINED IN SILICO AND IN VIVO STUDIES ON ACUTE INFLAMMATION. Yoram Vodovotz Trauma and hemorrhagic shock elicit an acute inflammatory response, predisposing patients to sepsis, organ dysfunction, and death. Few approved therapies exist for these acute inflammatory states, mainly due to the complex interplay of interacting inflammatory and physiologic elements working at multiple levels. Mathematical modeling of complex systems is an approach for understanding the interplay among the plethora of biological interactions. We constructed a mathematical model using ordinary differential equations that encompass the dynamics of cells and cytokines of the acute inflammatory response, as well as global tissue dysfunction. More recently, the model was augmented with elements of adaptive immunity. The model was calibrated separately in various strains of mice, rats, swine, and humans subjected to various acute inflammatory insults. Software was created that facilitated fitting of the mathematical model to experimental data, as well as for simulation of experiments with various inflammatory challenges and associated variations (gene knockouts, inhibition of specific cytokines, etc.). Using this software, the C57Bl/6 mousespecific model was recalibrated for inflammatory analyte data in CD14 j/j mice, and was used to elucidate altered features of inflammation in these animals. Similar methodology was used to elucidate mechanisms of inflammatory changes associated with Abstracts 1 Copyright @ 2006 by the Shock Society. Unauthorized reproduction of this article is prohibited. aging and novel drug therapy in mice. A model-derived hypothesis that underlying trauma is the central driver of inflammation and organ damage following hemorrhagic shock was validated with data on circulating markers and on the liver transcriptome in mice. Simulations of reversible and irreversible hemorrhagic shock in mice were also carried out. Studies in other pre-clinical paradigms of inflammation and wound healing, as well as other experimental animal species, are ongoing. Mathematical modeling may provide insights into the complex dynamics of acute inflammation in a manner that can be tested in vivo.

Veterinary surgery : VS, 2018

D-dimer is a specific marker of active coagulation and fibrinolysis. The objective of this study is to determine the influence of surgery on D-dimer concentration as well as to examine the relation between the magnitude of change and invasiveness of the surgical procedures. Prospective clinical study. Forty-five client-owned dogs undergoing elective neutering (n = 15), elective orthopedic (n = 15), or posttraumatic orthopedic (n = 15) surgical procedures. Dogs undergoing elective neutering, elective orthopedic, and posttraumatic orthopedic surgical procedures were enrolled. D-dimer concentration, measured immediately prior to, immediately after, and 24 hours after surgery (T0, T1, and T24, respectively), was compared within and among study groups. D-dimer concentration was >250 ng/mL in 8 (18%) dogs at T0, in 9 (20%) at T1, and in 5 (11%) at T24. At T1 and T24, only 2 dogs had a D-dimer concentration >500 ng/mL, and it was <750 ng/mL in all dogs. There was no difference in ...

La circulación, más o menos difícil, en las grandes ciudades siempre se caracteriza por la gran confusión entre peatones y vehículos que estacionan y circulan, entre vehículos lentos y rápidos, y sus diferentes deseos de desplazamiento.

In April 2018, I attended an intensive ethnography training course at the University of Southampton. This is a reflective piece about the course and how it has influenced my thinking about my PhD project, specifically in relation to the methodology.