Oxygen supplementation is a cornerstone of supportive medical treatment for critically ill patients. We studied self-reported attitudes towards oxygen therapy and actual clinical practice of ICU... Show moreOxygen supplementation is a cornerstone of supportive medical treatment for critically ill patients. We studied self-reported attitudes towards oxygen therapy and actual clinical practice of ICU clinicians. We found that clinicians are concerned with oxygen induced lung injury and will change mechanical ventilation settings accordingly. However, we performed a large, randomized trial assessing whether a conservative oxygenation strategy resulted in reduced mortality compared to a liberal oxygenation strategy and found there was no significant difference in mortality between the two groups. This thesis has brought to light an important problem of studying ICU patients regarding the consent procedure. We had to exclude patients because no consent had been obtained, losing valuable data and risking selection bias. Afterwards we asked patients how they experienced participating in the trial and most were not aware of their participation but did agree with their participation. This challenges the feasibility of informed consent in critically ill patients. Moreover, we researched disturbances in the homeostasis of sodium and found that an increase in serum sodium was associated with mortality, even in patients with normonatremia and moderate hyponatremia. This challenges the assumption that correcting hyponatremia would lead to lower mortality. Show less
The main theme of this thesis, allosteric modulation effectuated through the sodium ion site of GPCRs, is inspired by the important role that this site appears to play in GPCR signaling. As... Show moreThe main theme of this thesis, allosteric modulation effectuated through the sodium ion site of GPCRs, is inspired by the important role that this site appears to play in GPCR signaling. As sodium ions are abundant under physiological conditions they may affect GPCR signaling considerably. Receptor activation causes a substantial rearrangement of the sodium ion site, suggesting an important role in this process. Chapter 2 reviews the current knowledge on allosteric modulation of amiloride and its derivatives binding to the sodium ion site of Class A GPCRs. Chapters 3 to 5 follow-up on the recent crystal structure of the adenosine A2A receptor with a sodium ion bound. Chapters 3 and 4 complement the crystal structure with additional results from combined biochemistry, biophysical, molecular dynamics, and mutational studies. Chapter 5 describes the synthesis of novel amiloride derivatives that bind in the sodium ion site but also protrude into the orthosteric binding site. In Chapters 3 to 5, radio-labeled ligands were used to quantify ligand binding to the receptor, and Chapter 6 describes an alternative approach towards ligand binding assays. Instead of using a radio-label, mass spectrometry was used to quantify binding of an unlabeled ligand to adenosine A1 and A2A receptors. Show less
