6-Thiouric acid (6-TUA) has the potential to be an important biomarker for the action of 6-mercaptopurine (6-MP), an immunosuppressive drug used in patients suffering from acute lymphoblastic leukemia (ALL). 6-TUA, a nonactive metabolite of 6-MP, is excreted in the urine, and routine monitoring of this metabolite can be useful in assessing the efficacy of 6-MP for immune system suppression in patients who have undergone stem cell replacement. In this work, electrochemical surface-enhanced Raman spectroscopy (EC-SERS) is used for the first time to study the adsorption and electrochemical behavior of 6-TUA at a nanostructured silver electrode surface, in both 0.1 M NaF and synthetic urine as supporting electrolytes. In addition, ab initio calculations were completed in an effort to understand the adsorption behavior. It was found that EC-SERS provided excellent signal for 6-TUA down to μM concentrations in synthetic urine and highlights the future potential of EC-SERS for rapid detection of important urine biomarkers at the patient point-of-care.
Chitin and chitosan are potentially useful and environmentally friendly biopolymers with a wide range of value-added applications. Effective and green technologies for isolation of these materials are potentially important. Here, we report the use of lactic acid for the demineralization of green crab shells. Green crab shells and lactic acid, produced during cheese making, are two waste streams that could be tapped for large-scale chitin and chitosan processing. We have studied the effect of concentration and temperature on the demineralization of green crab shells. An unusual calcium lactate/lactic acid complex was also isolated and crystallographically characterized. The results have implications not only for the use of weak acids in the isolation of chitin and chitosan but also for the use of lactic acid as a solvent in green chemistry.
ARTICLE HISTORY
Background:
Many patients feel an “adrenaline rush” or a vasovagal reaction when injected with lidocaine and epinephrine during wide awake surgery. The incidence of these reactions is not well documented in the literature.
Methods:
In total, 387 patients were prospectively injected with lidocaine and epinephrine for minor procedures without sedation between July 1, 2019 and November 1, 2020. A concentration of epinephrine with 1:100,000 in 2% lidocaine was injected, with most patients getting less than 20 mL of volume.
Results:
Eight (2.2%) of the patients had adrenaline rush symptoms, which included nervousness, anxiety, tremors, shaky feelings, flushing, diaphoresis, light-headedness, tingling, and “heart racing.” Seven patients (1.8%) experienced vasovagal responses, which included nausea, a feeling of being unwell, faint, or lightheaded, or had circumoral pallor.
Conclusions:
Patients run a low risk of feeling an adrenaline rush or vasovagal reaction when injected with lidocaine and epinephrine. Routinely advising patients that the adrenaline rush can happen, and that this is not an allergic reaction can be helpful to allay fear of the unknown and to prevent false allergy beliefs. Injecting patients lying down may decrease the incidence of vasovagal reactions by increasing cerebral blood flow with the advantage of gravity.
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