Alterations in Hemolymph Ion Concentrations and pH in Adult Daphnia magna in Response to Elevations in Major Ion Concentrations in Freshwater.

Increases in the concentrations of major ions (Na+ , K+ , Ca2+ , Mg2+ , Cl- ) in freshwater are a growing concern for ecosystem health. These increases may originate from anthropogenic activities such as road deicing, fracking spills, mining, and fertilizer application and have detrimental effects on freshwater organisms through disturbances in ionoregulation and acid-base balance. The cladoceran Daphnia magna is adapted for active ion uptake and reduction of ion loss to maintain osmotic balance, but alterations in ionic composition of the environmental water are associated with toxicity. In the present study, hemolymph ion concentrations were measured using ion-selective microelectrode techniques. Increases in the hemolymph concentrations of Na+ and K+ correspond to elevations in the concentrations of these ions in ambient water. Water concentrations associated with sustained increases in hemolymph ion concentrations correlate well with median lethal concentration values from previous toxicology studies, indicating that Na+ and K+ concentrations in hemolymph may predict toxicity. When water K+ concentration is increased, a simultaneous increase in water Na+ concentration mitigates the increase in hemolymph K+ concentration, a finding which is consistent with the reported mitigation of K+ toxicity by Na+ . When ambient concentrations of K+ , Na+ , and Cl- are increased, not only is there a rise in hemolymph ion concentration but hemolymph pH is altered and pH regulation appears to be prioritized over regulation of hemolymph Na+ , K+ , and Cl- in D. magna. Environ Toxicol Chem 2021;40:366-379. © 2020 SETAC.

Establishing the thematic framework for a diabetes-specific health-related quality of life item bank for use in an english-speaking asian population.

AIMS: To establish a thematic framework for a Diabetes Mellitus (DM)-specific health-related quality of life (HRQoL) item bank by identifying important HRQoL themes and content gaps in existing DM-specific HRQoL measures and determining whether Patient-Reported Outcomes Measurement Information System (PROMIS) item banks are useful as a starting point. METHODOLOGY: English-speaking Type 2 DM patients were recruited from an outpatient specialist clinic in Singapore. Thematic analysis was performed through open coding and axial coding. Items from four existing DM-specific measures and PROMIS Version 1.0 and 2.0 item banks were compared with identified themes and sub-themes. RESULTS: 42 patients participated (25 men and 17 women; 28 Chinese, 4 Malay, 8 Indians, 2 other ethnicities). Median age was 53.70 years (IQR45.82-56.97) and the median disease duration was 11.13 (SD9.77) years. 10 subthemes (neutral emotions, coping emotions, empowered to help others, support from family, spend more time with family, relationships, financial burden on family, improved relationship, social support and religion/spirituality) were not covered by existing DM-specific measures. PROMIS covered 5 of 6 themes, 15 of 30 subthemes and 19 of 35 codes identified. Emotional distress (frustration, fear and anxiety) was most frequently mentioned (200 times). CONCLUSIONS: We had developed a thematic framework for assessing DM-specific HRQoL in a multi-ethnic Asian population, identified new items that needed to be written and confirmed that PROMIS was a useful starting point. We hope that better understanding and measurement of HRQoL of Asian DM patients will translate to better quality of care for them.

A retrospective review of autonomic screening tests conducted at a Tertiary General Hospital.

Autonomic screening tests (AST) are useful for assessing autonomic dysfunction. Our aim was to delineate the referral pattern, abnormalities, technical difficulties and final diagnoses of ASTs at a Tertiary General Hospital. Referring diagnoses was classified into: orthostatic symptoms, assessment of known/suspected disease associated with dysautonomia, thermoregulatory complaints and neurological disorders. Medication history, patient cooperation and test results were collated. Usefulness of AST in answering the clinical questions was ranked on a 3-point scale. 248 patients were studied. Orthostatic symptoms were the commonest referring diagnosis (71.4%) followed by assessment of a known/suspected disease associated with dysautonomia (13.3%), thermoregulatory complaints (7.7%) and neurological disorders (7.3%). 49.6% of ASTs were abnormal, 40.7% were normal and 9.7% were inconclusive. The first 2 referral categories had the highest proportion of abnormal ASTs while only 5.3% of patients with thermoregulatory complaints had abnormal AST. The most frequent final diagnosis was orthostatic hypotension (OH). It was seen in 31.7% of the cohort; however, 41% of these were attributed to medications. With regard to answering the clinical question, ASTs were very helpful in 56.0% and not helpful in 9.3%. 58.0% of inconclusive ASTs were attributed to poor performance of test maneuvers, 8.0% to medications, 17.0% to both and 17.0% to irregular heart rhythms and pacemakers. 34.7% of patients with diabetes mellitus and 38.2% of patients with Parkinsonism had signs of autonomic dysfunction. About 7% of diabetic and a quarter of Parkinsonism patients had OH secondary to medications. We believe these findings can contribute to better application of AST.