Determinants of Kidney Function and Accuracy of Kidney Microcysts Detection in Patients Treated With Lithium Salts for Bipolar Disorder

Objectives: Early kidney damage during lithium treatment in bipolar disorder is still hypothetical. We aimed at identifying the determinants of a decreased measured glomerular filtration rate (mGFR) and the accuracy of kidney MRI imaging in its detection.Methods: In this cross-sectional cohort study, 217 consecutive lithium-treated patients underwent mGFR and kidney MRI with half-Fourier turbo spin-echo and Single-shot with long echo time sequences.Results: Median age was 51 [27–62] years, and median lithium treatment duration was 5 [2–14] years. 52% of patients had a stage 2 CKD. In multivariable analysis, the determinants of a lower mGFR were a longer lithium treatment duration (β −0.8 [−1; −0.6] ml/min/1.73 m2 GFR decrease for each year of treatment), a higher age (β −0.4 [−0.6; −0.3] ml/min/1.73 m2 for each year of age, p < 0.001), albuminuria (β −3.97 [−6.6; −1.3], p = 0.003), hypertension (β −6.85 [−12.6; −1.1], p = 0.02) and hypothyroidism (β −7.1 [−11.7; −2.5], p = 0.003). Serum lithium concentration was not associated with mGFR. Renal MRI displayed renal microcyst(s) in 51% of patients, detected as early as 1 year after lithium treatment initiation. mGFR and lithium treatment duration were strongly correlated in patients with microcyst(s) (r = −0.64, p < 0.001), but not in patients with no microcysts (r = −0.24, p = 0.09). The presence of microcysts was associated with the detection of an mGFR <45 ml/min/1.73 m2 (AUC 0.893, p < 0.001, sensitivity 80%, specificity 81% for a cut-off value of five microcysts).Conclusion: Lithium treatment duration and hypothyroidism strongly impacted mGFR independently of age, especially in patients with microcysts. MRI might help detect early lithium-induced kidney damage and inform preventive strategies.

Investigation of Fast-Charging and Degradation Processes in 3D Silicon–Graphite Anodes

The 3D battery concept applied on silicon–graphite electrodes (Si/C) has revealed a significant improvement of battery performances, including high-rate capability, cycle stability, and cell lifetime. 3D architectures provide free spaces for volume expansion as well as additional lithium diffusion pathways into the electrodes. Therefore, the cell degradation induced by the volume change of silicon as active material can be significantly reduced, and the high-rate capability can be achieved. In order to better understand the impact of 3D electrode architectures on rate capability and degradation process of the thick film silicon–graphite electrodes, we applied laser-induced breakdown spectroscopy (LIBS). A calibration curve was established that enables the quantitative determination of the elemental concentrations in the electrodes. The structured silicon–graphite electrode, which was lithiated by 1C, revealed a homogeneous lithium distribution within the entire electrode. In contrast, a lithium concentration gradient was observed on the unstructured electrode. The lithium concentration was reduced gradually from the top to the button of the electrode, which indicated an inhibited diffusion kinetic at high C-rates. In addition, the LIBS applied on a model electrode with micropillars revealed that the lithium-ions principally diffused along the contour of laser-generated structures into the electrodes at elevated C-rates. The rate capability and electrochemical degradation observed in lithium-ion cells can be correlated to lithium concentration profiles in the electrodes measured by LIBS.

Influence of alkaline pre-treatment on acid dissolution of cathode material of 18650 lithium battery

Lithium battery cathodes contain lithium, cobalt, nickel, and manganese. Recycling of spent lithium batteries aims to recover these elements for re-use. Liberation of cathode materials from other metals in the battery such as aluminium, copper, and iron, is essential to obtain a good leaching efficiency in the recovery of valuable metals from end-of-life lithium batteries. This study investigates the behaviour of cathode materials and other metals in spent 18650 lithium batteries during leaching in H2SO4 solution with and without NaOH pre-treatment. Dissolution of aluminium using NaOH is a selective method to separate the metal from other elements. The influence of a 2-hour NaOH pre-treatment on subsequent acid leaching of cathode materials was investigated at both room temperature and 80°C. The extraction of aluminium increased to 75% at a higher temperature. Lithium concentration in the pregnant leach solution from acid leaching also increases with NaOH pre-treatment. The pre-treatment had a negligible effect on nickel, manganese, iron, and copper extraction. However, the cobalt extraction with NaOH pre-treatment was significantly lower. The result was likely due to indirect impact of less hydrogen gas was generated from a lower Al amount. The lattice structure of the leach residue for the sample with NaOH pre-treatment was monoclinic rather than rhombohedral due to stronger delithiation.

Quantum Tunneling-Induced Membrane Depolarization Can Explain the Cellular Effects Mediated by Lithium: Mathematical Modeling and Hypothesis

Lithium imposes several cellular effects allegedly through multiple physiological mechanisms. Membrane depolarization is a potential unifying concept of these mechanisms. Multiple inherent imperfections of classical electrophysiology limit its ability to fully explain the depolarizing effect of lithium ions; these include incapacity to explain the high resting permeability of lithium ions, the degree of depolarization with extracellular lithium concentration, depolarization at low therapeutic concentration, or the differences between the two lithium isotopes Li-6 and Li-7 in terms of depolarization. In this study, we implemented a mathematical model that explains the quantum tunneling of lithium ions through the closed gates of voltage-gated sodium channels as a conclusive approach that decodes the depolarizing action of lithium. Additionally, we compared our model to the classical model available and reported the differences. Our results showed that lithium can achieve high quantum membrane conductance at the resting state, which leads to significant depolarization. The quantum model infers that quantum membrane conductance of lithium ions emerges from quantum tunneling of lithium through the closed gates of sodium channels. It also differentiates between the two lithium isotopes (Li-6 and Li-7) in terms of depolarization compared with the previous classical model. Moreover, our study listed many examples of the cellular effects of lithium and membrane depolarization to show similarity and consistency with model predictions. In conclusion, the study suggests that lithium mediates its multiple cellular effects through membrane depolarization, and this can be comprehensively explained by the quantum tunneling model of lithium ions.

Evaluation of the utilization of extracorporeal toxin removal in lithium poisoning patients in Hong Kong

Background: Extracorporeal toxin removal is used for enhanced elimination in severe lithium poisoning. The Extracorporeal TReatments In Poisoning workgroup provides recommendations on the use of extracorporeal toxin removal in poisoning. Objectives: Our aim was to identify the pattern for using extracorporeal toxin removal in managing lithium poisoning in Hong Kong and compare the outcomes in extracorporeal toxin removal-treated patients and non-extracorporeal toxin removal-treated patients if indicated for treatment as defined by The Extracorporeal TReatments In Poisoning criteria. Methods: Lithium poisoning presented between year 2009 and 2019 in Hong Kong Poison Information Centre (HKPIC) database was categorized into extracorporeal toxin removal-treated group and non-extracorporeal toxin removal-treated group. Comparative analyses were performed. Results: Among 112 lithium-poisoned patients, 21% were treated with extracorporeal toxin removal. Larger proportion of patients had fulfilled at least one Extracorporeal TReatments In Poisoning criteria for extracorporeal toxin removal in the extracorporeal toxin removal-treated group (87% vs 18%, p < 0.005). The extracorporeal toxin removal-treat group patients were more commonly presented with impaired consciousness, seizure and dysrhythmia ( p < 0.05). They also got higher admission (3.62 mmol/L vs 2.18 mmol/L, p < 0.05) and peak (4.15 mmol/L vs 2.28 mmol/L, p < 0.05) serum lithium concentrations, as well as a significantly higher serum creatinine concentration upon presentation (263.74 µmol/L vs 98.66 µmol/L, p < 0.05). Extracorporeal toxin removal-treat group patients more frequently had a severe poisoning outcome (91.3% vs 9%, p < 0.05) and developed complications (69.6% vs 13.5%, p < 0.05). Logistic regression identified seizure, peak serum lithium concentration, and serum creatinine concentration upon presentation as risk factors for severe poisoning outcome. In subgroup analysis on patients with at least one indication for extracorporeal toxin removal as defined by Extracorporeal TReatments In Poisoning criteria, the proportion of severe poisoning remained higher in the extracorporeal toxin removal-treated group (90% vs 43.7%, p < 0.05). Complication rate was not significantly different between the two groups. Conclusion: Clinically severe lithium poisoning patients were treated with extracorporeal toxin removal in Hong Kong. Extracorporeal TReatments In Poisoning criteria can serve as a reference in considering extracorporeal toxin removal treatment for lithium poisoning patients. Nevertheless, Extracorporeal TReatments In Poisoning criteria recommend more extracorporeal toxin removal treatment than it was actually done. Lithium poisoning patients with positive Extracorporeal TReatments In Poisoning criteria have been managed without extracorporeal toxin removal. No statistically significant adverse outcome was observed in these cases.

Neonatal Feeding Trajectories in Mothers With Bipolar Disorder Taking Lithium: Pharmacokinetic Data

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories.Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ).Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6–8, 7–8, and 53–60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively.Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.

Changes in Lithium Levels in Bees and Their Products Following Anti-Varroa Treatment

The biggest threat to beekeeping is varroosis caused by the mite Varroa destructor. Chemicals available to treat this fatal disease may present problems of resistance or inconsistent efficacy. Recently, lithium chloride has appeared as a potential alternative. To date, the amount of residue lithium treatments may leave in honeybee products is poorly understood. Honeybees were fed with 25 mM lithiated sugar syrup, which was used in earlier studies. The accumulation and elimination of the lithium were monitored in bees and their products for 22 days. Lithium concentration increased in the entire body of the bees to day 4 post-treatment and then recovered rapidly to the control level. Lithium exposure was found to affect uncapped honey in the short term (<16 days), but ripe (capped) honey measured at the end of the trial remained affected. On the other hand, lithium treatment left beeswax lithium-free. Based on these data, we propose that comprehensive research on harvested honey is needed to decide on the veterinary use of lithium.