Unveiling the potential impact of vitamin C in postoperative spinal pain.

BACKGROUND: Spinal surgery is a common procedure associated with significant postoperative pain, and identifying effective interventions to manage this pain is crucial for optimizing patient outcomes. This review assesses the existing literature to determine the overall impact of vitamin C supplementation on spinal postoperative pain. Vitamin C, also known as ascorbic acid, is an essential nutrient that plays a vital role in numerous physiological processes. It functions as a potent antioxidant, neutralizing free radicals and reducing oxidative stress within the body. Furthermore, vitamin C is a cofactor in collagen synthesis, a crucial component of connective tissues, including those found in the spinal structures. Given its antioxidant and collagen-promoting properties, vitamin C has piqued interest as a potential therapeutic option for postoperative spinal pain. Based on the available evidence, vitamin C may have a beneficial effect on postoperative spinal pain, including reducing pain scores, analgesic consumption, and the incidence of complications such as complex regional pain syndrome. However, more research is needed to fully understand the optimal dosage and duration of vitamin C supplementation for postoperative pain management. CONCLUSION: Vitamin C could be considered a potentially beneficial adjunctive therapy for managing spinal postoperative pain, but its routine use requires further investigation.

Optimization of process parameters of refractance window drying for aonla slices and comparison with other drying techniques.

BACKROUND: Aonla is as a good source of antioxidants due to its high ascorbic acid and polyphenol contents. However, because of its high acidity and astringent taste, aonla is rarely consumed in its fresh form. As the constituents in aonla are heat sensitive, it is essential to find a suitable drying method for preservation. Therefore, refractance window drying (RWD) of aonla slices was studied as it has the potential of retaining heat-sensitive compounds. RESULTS: The effect of RWD process variables, namely water temperature (75, 82.5, 90 °C) and slice thickness (2, 4, 6 mm), on different quality parameters of dehydrated aonla was studied. Increasing water temperature resulted in significantly higher ascorbic acid content, titratable acidity and product temperature, while total phenolic content, free radical scavenging activity and moisture content decreased. With the exception of product temperature, higher slice thickness led to an increase in the values of all the parameters. At the optimized processing conditions of 83 °C water temperature and 4 mm slice thickness, the ascorbic acid content, total phenolic content, free radical scavenging activity, titratable acidity and moisture content values were found to be 269.03 mg (100 g)-1, 242.33 mg (100 g)-1, 87.11%, 3.62% and 4% respectively. The aonla slices subjected to RWD also possessed 4-6% higher phytochemical content than osmotically dried and hot-air-dried samples. CONCLUSION: This research highlights the effectiveness of RWD in preserving heat-sensitive compounds in food like aonla. The RW-dried slices had a smoother and more uniform microstructure compared to osmotically dried and hot-air-dried samples. © 2024 Society of Chemical Industry.

High performance Pt-anchored MoS2 based chemiresistive ascorbic acid sensor.

Ascorbic acid (AA), known as Vitamin C, is a vital bioactive compound that plays a crucial role in several metabolic processes, include the synthesis of collagen and neurotransmitters, the removal of harmful free radicals, and the uptake of iron by cells in the human intestines. As a result, there is an absolute need for a highly selective, sensitive, and economically viable sensing platform for ascorbic acid (AA) detection. Herein, we demonstrate a Pt-decorated MoS2 for efficient detection of an AA biosensor. MoS2 hollow rectangular structure were synthesised using an easy and inexpensive chemical vapor deposition (CVD) approach to meet the increasing need for a reliable detection platform. The synthesized MoS2 hollow rectangular structure are characterized through field effect scanning electron microscopy (FESEM), energy-dispersive spectroscopy (EDX) elemental mapping, Raman spectroscopy, and X-ray photoelectron spectroscopy (XPS). We fabricate the chemiresistive biosensor based on Pt-decorated MoS2 that measures AA with great precision and high sensitivity. The experiments were designed to evaluate the response of the Pt-decorated MoS2 biosensor in the presence and absence of AA, and selectivity was evaluated for a variety of biomolecules, and it was observed to be very selective towards AA. The Pt-MoS2 device had a higher response of 125% against 1mM concentration of AA biomolecules, when compared to that of all other devices and 2.2 times higher than that of the pristineMoS2 device. The outcomes of this study demonstrate the efficacy of Pt-decorated MoS2 as a promising material for AA detection. This research contributes to the ongoing efforts to enhance our capabilities in monitoring and detecting AA, fostering advancements in environmental, biomedical, and industrial applications. .

Preoperative and postoperative administration of vitamin C in cardiac surgery patients - settings, dosages, duration, and clinical outcomes: a narrative review.

Vitamin C or ascorbic acid is a water-soluble vitamin capable of directly donating electrons to reactive oxygen species, attenuating electrical remodeling, and cardiac dysfunction in patients undergoing cardiac surgery (CS), considered one of the most effective defenses against free radicals in the blood, thus being one of the first antioxidants consumed during oxidative stress. The aim of this review is to assess the effects of perioperative administration of vitamin C in CS patients. A comprehensive literature search was conducted in order to identify prospective cohort studies and/or randomized controlled trials reporting on the perioperative effects of vitamin C among adult patients undergoing CS. Studies published between January 1980 to December 2022 were included in our search, resulting in a total of 31 articles that met all our inclusion criteria. There seems to be a beneficial effect of vitamin C supplementation in arrhythmias such as in postoperative atrial fibrillation, reduction of ICU length of stay, and hospital length of stay, reduction in postoperative ventilation time, in inotropic demand, and in postoperative fatigue. Vitamin C can act as a scavenger of free radicals to decrease the peroxidation of the lipids present in the cell membrane, and to protect the myocardium postoperatively from ischemia/reperfusion injury, thus attenuating oxidative stress and inflammation. It represents a readily available and cost-effective strategy that could improve the outcome of patients undergoing CS, by reducing the risk of serious cardiovascular adverse events, both perioperatively and postoperatively.

Renewed spectroscopic and theoretical research of hydrogen bonding in ascorbic acid.

The studies of two isomers of ascorbic acid and their deuteroanalogues, presented in the paper, have been accomplished by vibrational spectroscopy methods and quantum-chemical simulations. The spectroscopic research of L-ascorbic and D-isoascorbic acids have been carried out by the infrared (IR) and Raman (R) techniques. On the basis of the obtained results the spectral interpretation of the hydrogen bonded groups of ascorbic acids has been performed. Car-Parrinello Molecular Dynamics (CPMD) and Density Functional Theory (DFT) have been employed to support spectroscopic experimental findings and shed light onto the bridged proton dynamics in the L- and D- isomers of ascorbic acids. The accurate assignments of the hydrogen bond modes have been accomplished with the application of deuterosubstitution, CPMD-solid state simulations and Potential Energy Distribution (PED) analysis. The spectral and structural results have shown that dependency ν(OH) = f(γ(OH)) is the most common for the OHO hydrogen bond, whereas dependency d(OO) = f(γ(OH)) differs as for the ionic and resonance assisted hydrogen bonds.

Multifunctional N, Fe-doped carbon dots with peroxidase-like activity for the determination of H2O2 and ascorbic acid and cell protection against oxidation.

Multifunctional N, Fe-doped carbon dots (N, Fe-CDs) were synthesized by the one-step hydrothermal method using ferric ammonium citrate and dicyandiamide as raw materials. The N, Fe-CDs exhibited peroxidase-like (POD) activity by catalyzing the oxidization of 3,3',5,5'-tetramethylbenzidine (TMB) to the green oxidation state ox-TMB in the presence of hydrogen peroxide (H2O2). Subsequently, based on the POD activity of N, Fe-CDs, an efficient and sensitive colorimetric method for the detection of H2O2 and ascorbic acid (AA) was established with a limit of detection of 0.40 µM and 2.05 µM. The proposed detection method has been successfully applied to detect AA in fruit juice, vitamin C tablets, and human serum samples and has exhibited excellent application prospects in biotechnology and food fields. Furthermore, N, Fe-CDs also showed a protective effect on the cell damage caused by H2O2 and could be used as an antioxidant agent.

The Use of High-Dose Intravenous L-Ascorbate in Pain Therapy: Current Evidence from the Literature.

INTRODUCTION: Pain is the most common reason for seeking medical treatment. Despite extensive research efforts and effective analgesics modulating pain, there is still a major therapeutic gap in addressing the root causes of pain. Pain is associated with tissue damage induced by oxidative stress and induction of inflammatory mediators following high consumption of antioxidants. The role of antioxidants in general, and the administration of L-ascorbate in particular, is still controversially discussed and underestimated in the daily clinical practice. METHODS: The current literature on the therapeutic effect of L-ascorbate, ascorbic acid, and vitamin C on various pain conditions was evaluated against the background of evidence-based medicine. Those articles, obtained from systematic search in PubMed, were critically assessed and rated in terms of evidence level and methodological quality by two independent experts. The primary purpose of this work was to establish specific pain therapy guidance for intravenous L-ascorbate. RESULTS: A PubMed search revealed 14 suitable articles comprising controlled clinical trials and meta-analyses. An additional ten publications could be identified via secondary literature. There is supporting evidence for the efficacy of ascorbate treatment in inflammatory pain conditions, in the complex regional pain syndrome, in post zoster neuralgia, in neuropathic pain, in post-operative pain conditions, and in tumor-related pain. However, the considered studies differ in the type of administration, in dosage, in duration of treatment, as well as in quality of research. Despite all study heterogeneity, it became evident that research of high scientific quality is in support of the efficacy of L-ascorbate in pain treatment. DISCUSSION: Oxidative stress is present in almost all pain conditions. Because oral administration of most magistral formulas of vitamin C does not provide biological availability, parenteral administration should be preferred and can be supported by an oral dose with high bioavailability on days without intravenous treatment. L-ascorbate should be preferred for parenteral high dosage, rather than ascorbic acid, as it does not release acid valences under physiological conditions. CONCLUSIONS: L-ascorbate is an effective, safe, and economically favorable integrative treatment option for various pain conditions, addressing the root cause of tissue damage and inflammatory mediator burst.

Development of an "on-off-on" fluoroprobe utilizing an anthrylimidazole-based fluorescent ionic liquid for sensitive Cr(VI) and ascorbic acid detection.

Developing a rapid detection method of Cr(VI) and ascorbic acid (AA) is vital in the food and environmental fields. Herein, an anthrylimidazole-based fluorescent ionic liquid (AI-FIL) with the advantageous fluorescent properties was successfully prepared and used to construct a promising "on-off-on" fluoroprobe for rapid/sensitive Cr(VI) and AA detection. Cr(VI) could effectively quench the fluorescence of AI-FIL owing to the inner-filter effect and photoinduced electron-transfer process. However, the decreased fluorescence could be rapidly recovered by AA owing to the redox reaction between AA and Cr(VI). For Cr(VI) detection, a satisfactorily linear response (0.03-300 µM) was achieved with the corresponding detection limit of 9 nM. For AA detection, a good linearity from 1 to 1000 µM was obtained with the resultant detection limit of 0.3 µM. Moreover, the AI-FIL based fluoroprobe was successfully utilized for Cr(VI) and AA detection in food and water samples with satisfactory accuracy and precision.

Reduction of surface treatment time by combination of citric acid and ascorbic acid while restoring shear bond strength of metal brackets bonded to bleached enamel: a pilot study.

BACKGROUND: To investigate the effect of a 50% ascorbic acid with 50% citric acid solution on the immediate shear bond strength (SBS) of metallic brackets after tooth bleaching. The enamel etching pattern and the required quantity of these combined acids as antioxidants following 35% hydrogen peroxide (HP) bleaching were also determined. METHODS: The stability of the solution at room temperature was assessed at various time intervals. Fifty teeth were randomly divided into five groups: non-bleached (G1), bleached then acid etched (G2), bleached followed by a 10-minute treatment with 10% sodium ascorbate and acid etched (G3), 5-minute treatment with 50% ascorbic acid (G4), and 5-minute treatment with a combination of 50% ascorbic acid and 50% citric acid (G5). Groups G2, G3, G4 and G5 were bleached by 35% HP gel for a total of 32 min. Acid etching in groups G1, G2, and G3 was performed using 37% phosphoric acid (Ormco®, Orange, CA, USA) for 15 s. In all groups, metal brackets were immediately bonded using Transbond™ XT primer and Transbond™ PLUS adhesive, with light curing for 40 s. The SBS was tested with a universal testing machine, and statistical analysis was conducted using one-way ANOVA followed by Tukey's HSD test. The level of significance was set at p < 0.05 for all statistical tests. RESULTS: Stability tests demonstrated that the combined acids remained effective for up to 21 days. Group G5 significantly increased the SBS of bleached teeth to the level of G1 (p < 0.05), while G3 did not achieve the same increase in SBS (p > 0.05). SEM analysis revealed enamel etching patterns similar to those of both control groups (G1 and G2). Kinetic studies at 6 min indicated that the antioxidation in G5 reacted 0.2 mmole lower than in G3 and G4. CONCLUSION: 5-minute application of the combined acids enhanced the SBS of bleached teeth comparable to unbleached teeth. The combined acids remain stable over two weeks, presenting a time-efficient, single-step solution for antioxidant application and enamel etching in orthodontic bracket bonding.

Study of KOH as alkali for enhancing performance of photo-galvanic cell in transparent cylindrical cell design.

Photo-galvanic cells are liquid electrolyte-based dye-sensitized solar cells. Chemically, the dye/pigment photo-sensitizer, reductant, surfactant, and alkali materials are the main fabrication components of these cells. Most dye/pigment materials are more soluble and stable at high pH. The pH of Potassium hydroxide (an alkali of plant nutrient 'potassium' element) is very high. Therefore, Potassium hydroxide is supposed to be the best eco-friendly and effective alkali medium for photogalvanics. As far as alkali is concerned, NaOH has been exploited extensively in photo-galvanics. Although, the NaOH-based photo-galvanics show good electrical output, it is plagued with some drawbacks like shorter shelf life, high cost, unsafe for skin, low conductivity, low water solubility, etc. Therefore, in the present research, the KOH has been exploited as an alkali material for harvesting solar energy using the Sunset Yellow FCF dye sensitizer-Ascorbic acid reductant-CTAB surfactant cylindrical cell designed photo-galvanic system. In the present study, the observed optimum cell performance is as follows-open-circuit potential 777 mV, maximum current 25000 µA, short-circuit current 5600 µA, power 733.6 µW, fill factor 0.16, and efficiency is 19.77 % at pH 14.30. The Sunset Yellow FCF dye shows very high photostability and photo-absorption with KOH alkali. The power storage capacity is sufficiently robust, as the cell is capable of supplying power at its ∼36.16 % capacity after a very long time of 24 h. The KOH-Sunset Yellow FCF dye sensitizer-Ascorbic acid reductant-CTAB surfactant photo-galvanics in the present study show improved results over the reported results for the NaOH-Sunset Yellow FCF dye sensitizer-Ascorbic acid reductant-CTAB surfactant photo-galvanics. The reasons for the good photo-galvanics with KOH alkali may be attributed to some peculiar chemical and physical properties of KOH vis-à-vis the chemical and physical properties of NaOH.

Exploring Ascorbic Acid's Role in Orthopedic Practices: Present Theories, Innovative Approaches, and Prospects.

In the human body, ascorbic acid (AA) is known for its potent antioxidant and reducing properties and also plays a vital role in supporting the growth of bones and cartilage. It has been used extensively in orthopedic surgery. Ongoing studies under the umbrella of ascorbic acid research investigate its impact on bone and tendon physiology, as well as its influence on joint replacement and postoperative pain. The majority of both laboratory and human studies link the usage of ascorbic acid to enhanced bone health and improved tendon healing. Recent literature suggest that ascorbic acid administration may have a positive impact on the outcome of orthopedic procedures. On the other hand, controversy exists regarding the efficacy of ascorbic acid in reducing the incidence of complex regional pain syndrome. In brief, the effectiveness of ascorbic acid in enhancing orthopedic procedure outcomes remains a subject of ongoing investigation. Although certain studies have hinted at the potential positive influence of ascorbic acid on these outcomes, further research is required to validate its effectiveness and ascertain the ideal dosage and method of administration for maximizing its anticipated advantages. To establish the efficacy of ascorbic acid in improving orthopedic procedure outcomes, rigorous human trials of high quality are imperative. The aim of this review was to provide an overview of ascorbic acid's utilization in orthopedic practices and to pinpoint prospective areas for future research.

The Synthesis of FeS and Investigation on Electrochemical Sensing Toward Neuroprotector.

Background Electrochemical sensing is a versatile field that uses electrochemistry concepts to detect and measure various substances. It finds applications in clinical diagnostics and environmental monitoring. Scientists are currently working on creating reliable electrochemical sensing devices that can accurately detect ascorbic acid. Iron sulfide (FeS) has emerged as a promising material for these sensors due to its excellent electrical conductivity, catalytic activity, and stability.  Materials and methods The FeS nanoparticles were synthesized through the hydrothermal method of synthesis. The glassy carbon electrode (GCE) with a surface area of 0.071 cm2 was modified with FeS before the working electrode was mechanically polished with 1 µm, 0.3 µm, and 0.05 µm alumina pastes for mirror finishing. Then it was subjected to ultrasonication in double distilled water for a few minutes to clean the surface of GCE. The FeS suspension was prepared by dispersing 5 mg of FeS in 10 mL of ethanol during 20 minutes of ultrasonic agitation then the GCE was coated with 10 µL of the suspension by drop coating method and dried in air. Results In this study, FeS nanoparticles were synthesized by the hydrothermal method of synthesis, and it was tested for their electrochemical sensing properties by various tests. Based on the field emission-scanning electron microscope (FE-SEM) analysis, scan rate effect test, cyclic voltammetric test, X-ray diffraction (XRD), and energy-dispersive X-ray (EDX) spectroscopy analysis done and results obtained, it was seen that the synthesized FeS nanoparticles are highly pure and have a crystalline structure. FeS has an even morphology. The synthesized particles also showed highly sensitive and specific sensing toward ascorbic acid when compared to unmodified 10.1 µA electrodes with a sensing value of 12.51 µA, thereby fulfilling the aim of this study. Conclusion Based on the outcomes of the diverse tests carried out, it is evident that the sample displayed a high crystalline nature as indicated by the XRD test. Additionally, the sample exhibited a uniform morphology, exceptional stability, and remarkable sensitivity. The developed FeS-based electrochemical sensor was found to be exceptionally pure and showed excellent performance, showcasing both high sensitivity and selectivity toward ascorbic acid.

Scurvy in an Adolescent: A Case Report.

Scurvy is a rare condition characterized by a deficiency in dietary vitamin C. Historically a disease taught in the context of long ocean voyages with limited vitamin intake, it is now rare in developed nations. The classical physical exam findings include gingival bleeding, perifollicular hemorrhages, and corkscrew hairs. We discuss the case of a 15-year-old female with scurvy whose initial presentation suggested more common diagnoses seen in the emergency department setting. Her course was complicated by a prior history of anorexia nervosa and a restrictive diet that lacked necessary vitamins. Once the patient's dietary habits were identified, a detailed physical exam revealed the characteristic findings. She was subsequently discharged with oral vitamin C supplements and was scheduled for outpatient follow-up to monitor symptoms.

Vitamin C deficiency after kidney transplantation: a cohort and cross-sectional study of the TransplantLines biobank.

PURPOSE: Vitamin C deficiency is associated with excess mortality in kidney transplant recipients (KTR). We aim to evaluate plasma vitamin C status at different post-transplantation moments and assess the main characteristics associated with vitamin C deficiency in KTR. METHODS: Plasma vitamin C was assessed in 598 KTR at 3-, 6-, 12-, 24-, and 60-months post-transplantation, 374 late KTR with a functioning graft ≥ 1 year, and 395 potential donors. Vitamin C deficiency was defined as plasma vitamin C ≤ 28 µmol/L. Diet was assessed by a 177-item food frequency questionnaire. Data on vitamin C-containing supplements use were extracted from patient records and verified with the patients. RESULTS: Vitamin C deficiency ranged from 46% (6-months post-transplantation) to 30% (≥ 1 year post-transplantation). At all time points, KTR had lower plasma vitamin C than potential donors (30-41 µmol/L vs 58 µmol/L). In cross-sectional analyses of the 953 KTR at their first visit ≥ 12 months after transplantation (55 ± 14 years, 62% male, eGFR 55 ± 19 mL/min/1.73 m2), the characteristics with the strongest association with vitamin C deficiency were diabetes and smoking (OR 2.67 [95% CI 1.84-3.87] and OR 1.84 [95% CI 1.16-2.91], respectively). Dietary vitamin C intake and vitamin C supplementation were associated with lower odds (OR per 100 mg/day 0.38, 95% CI 0.24-0.61 and OR 0.21, 95% CI 0.09-0.44, respectively). CONCLUSION: Vitamin C deficiency is frequent among KTR regardless of the time after transplantation, especially among those with diabetes and active smokers. The prevalence of vitamin C deficiency was lower among KTR with higher vitamin C intake, both dietary and supplemented. Further research is warranted to assess whether correcting this modifiable risk factor could improve survival in KTR.

Molecular dynamics simulations of choline chloride and ascorbic acid deep eutectic solvents: Investigation of structural and dynamics properties.

Deep eutectic solvents (DESs) composed of choline chloride (ChCl) and ascorbic acid (AA) were investigated using the molecular dynamics (MD) simulations. The analyses of the configuration, radial distribution function (RDFs), coordination number, spatial distribution function (SDFs), interaction energies, hydrogen bond number, and self-diffusion coefficient of the ChCl/AA binary systems of different concentrations showed that the stability of the hydrogen bond network and the mutual attraction between systems were the strongest at the experimental eutectic concentration (molar ratio of 2:1). In our simulated temperature range from 303.15 to 353.15 K, the hydrogen bonding network of ChCl/AA DES does not undergo considerable alterations, indicating that its stability was insensitive to temperature. In addition, the influence of the water content on the ChCl/AA DES system was further investigated. The simulated results revealed that the water molecules could disrupt the formation of the hydrogen bonding network by occupyin positions that are essential for the formation of hydrogen bonds within the DES system.

An apple a day keeps the doctor away: pediatric scurvy case report and mini review.

Scurvy is a rare nutritional disorder caused by deficiency of ascorbic acid (vitamin C). It is often under-diagnosed in clinical settings, especially in North America where population statistics are unavailable. However, scurvy is more common than previously thought and appears to be re-emerging in children with developmental delays. Here, we review the pertinent literature and present a case of a previously healthy, 5-year-old, non-verbal boy who presented with multiple, acute, and subacute spontaneous epidural hemorrhages managed by neurosurgical intervention. He remained in hospital for 17 days and was seen in follow-up 3 weeks post-operatively having returned to his neurological baseline. Our case suggests the importance of considering scurvy in patients who have developmental delays and poor nutritional status.

Ascorbic acid-mediated reduction of arabinoxylan viscosity through free radical reactions.

Arabinoxylan (AX) is a potential natural food additive that can enhance the textural properties of food. However, the addition of ascorbic acid (AA) can easily lead to a decrease in the viscosity of AX, which poses a challenge in the development of AX-rich foods. Therefore, the purpose of this study is to elucidate the mechanisms behind the reduction in AX viscosity in the presence of AA. The results indicated that AA could reduce the apparent viscosity and molecular weight of AX without significantly affecting the monosaccharide composition, suggesting a potential mechanism related to the cleavage of AX glycosidic bonds. Interestingly, free radicals were present in the reaction system, and the generation of free radicals under different conditions was consistent with the reduction in apparent viscosity of AX. Furthermore, the reduction in AX apparent viscosity by AA was influenced by various factors including AA concentration, reaction time, temperature, pH, and metal ions. These findings suggested that the mechanism of AX degradation may be due to AA-induced free radical generation, leading to non-selective attacks on glycosidic bonds. Therefore, this study revealed that the potential mechanism behind the reduction in AX viscosity induced by AA involved the generation of ascorbic acid radicals.

Metabolomics reveals ascorbic acid inhibits ferroptosis in hepatocytes and boosts the effectiveness of anti-PD1 immunotherapy in hepatocellular carcinoma.

BACKGROUND: Immunotherapy combined with molecular targeted therapy is increasingly popular in patients with advanced hepatocellular carcinoma (HCC). However, immune-related adverse events(irAEs) brought on by immunotherapy increase the likelihood of side effects, thus it is important to look into ways to address this issue. METHODS: Different metabolite patterns were established by analyzing metabolomics data in liver tissue samples from 10 patients(divided into severe and mild liver injury) before and after immuno-targeted therapy. After establishing a subcutaneous tumor model of HCC, the mice were divided into PBS group, ascorbic acid(AA) group, and anti-PD1 + tyrosine kinase inhibitor (TKI) group, anti-PD1 + TKI + AA group. Liver tissue were stained with hematoxylin-eosin staining(HE) and the content of aspartate transaminase (AST) and alanine transaminase(ALT) in blood were determined. The mechanism was confirmed by western blotting, mass cytometry, and other techniques. RESULTS: Through metabolomics analysis, AA was significantly reduced in the sample of patients with severe liver injury caused by immuno-targeted therapy compared to patients with mild liver injury. The addition of AA in vivo experiments demonstrated a reduction in liver injury in mice. In the liver tissues of the anti-PD1 + TKI + AA group, the protein expressions of SLC7A11,GPX4 and the level of glutathione(GSH) were found to be higher compared to the anti-PD1 + TKI group. Mass cytometry analysis revealed a significant increase in the CD11b+CD44+ PD-L1+ cell population in the AA group when compared to the PBS group. CONCLUSIONS: AA could reduce liver injury by preventing hepatocyte SLC7A11/GPX4 ferroptosis and improve the immunotherapy effect of anti-PD1 by boosting CD11b+CD44+PD-L1+cell population in HCC.

Ascorbic acid-induced warfarin resistance after breast cancer surgery: a case report and literature review.

Warfarin is an anticoagulant that requires INR-based dosage adjustment. Ascorbic acid may impair warfarin effectiveness according to limited literature. We report a rare case of a 63-year-old woman with an aortic valve replacement history who developed warfarin resistance after taking ascorbic acid for anemia following breast cancer surgery. Despite increasing the warfarin dose from 6 mg to 10 mg daily, her INR remained below the therapeutic range. After ruling out other causes of warfarin resistance, we discontinued ascorbic acid and observed a rapid increase in INR to target values. The temporal relationship and the absence of other confounding factors confirmed the causality of ascorbic acid in this case. We recommend that patients concomitantly taking vitamin C and warfarin should monitor their INR values closely and discontinue ascorbic acid as soon as possible if they exhibit signs of warfarin resistance.