Oxidation Reduction Potential

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Ashok Agarwal - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of seminal Oxidation Reduction Potential in male infertility
    Andrologia, 2021
    Co-Authors: Manesh Kumar Panner Selvam, Ashok Agarwal, Ralf Henkel, Renata Finelli
    Abstract:

    The role of oxidative stress in male infertility has been broadly recognised, and the search for a new marker to determine the redox environment in semen has gained considerable interest. Oxidation-Reduction Potential (ORP) or redox Potential, is a measure of the electron transfer from antioxidants to oxidants and provides information on the redox balance. In this review, the benefits of ORP as a new oxidative stress marker, the protocol for its evaluation and the importance of its measurement in the context of male infertility are discussed. In association with the standard semen analysis, seminal ORP has been analysed to evaluate semen quality and male fertility status. However, further studies are required to establish its use in assisted reproductive techniques (ART) practice.

  • Evaluation of seminal OxidationReduction Potential in male infertility
    Andrologia, 2020
    Co-Authors: Manesh Kumar Panner Selvam, Ashok Agarwal, Renata Finelli, Ralf Henkel
    Abstract:

    The role of oxidative stress in male infertility has been broadly recognised, and the search for a new marker to determine the redox environment in semen has gained considerable interest. Oxidation-Reduction Potential (ORP) or redox Potential, is a measure of the electron transfer from antioxidants to oxidants and provides information on the redox balance. In this review, the benefits of ORP as a new oxidative stress marker, the protocol for its evaluation and the importance of its measurement in the context of male infertility are discussed. In association with the standard semen analysis, seminal ORP has been analysed to evaluate semen quality and male fertility status. However, further studies are required to establish its use in assisted reproductive techniques (ART) practice.

  • seminal Oxidation Reduction Potential levels are not influenced by the presence of leucocytospermia
    Andrologia, 2020
    Co-Authors: Mohamed Arafa, Ashok Agarwal, Ralf Henkel, Renata Finelli, Ahmad Majzoub, Kathy Amy Robert, Haitham Elbardisi
    Abstract:

    Oxidative stress (OS) is characterised by an excessive amount of reactive oxygen species (ROS) which negatively affect sperm functions. In this study, the influence of leucocytes on seminal Oxidation-Reduction Potential (ORP) and sperm DNA fragmentation (SDF) was investigated in 1,068 men. Seminal leucocyte concentration did not correlate with SDF, unadjusted ORP, ORP normalised for sperm concentration (sORP), ORP normalised for total motile sperm concentration (motORP) or total motile sperm count (TMSC-ORP). Although receiver operator characteristic (ROC) curve analyses show that leucocytospermia does not predict high sORP values (>1.34 mV/106 spermatozoa/ml), the motORP (AUC: 0.666) and TMSC-ORP (AUC: 0.683) predict the rate of leucocytospermia significantly (p = .0195 and p = .0085 respectively). Moreover, SDF can significantly predict leucocytospermia (AUC: 0.679; p = .011) and vice versa (AUC: 0.657, p = .0298). Our data confirm the association between OS and SDF. In conclusion, motORP and TMSC-ORP may be better predictive factors of leucocytospermia, probably because sperm motility, included in motORP and TMSC-ORP calculation, is the first seminal parameter to be affected by OS. Although all these parameters are indicative of OS, ORP values, SDF and leucocytospermia should be considered independently for the evaluation of redox seminal status, as they probe distinct seminal features.

  • Seminal Oxidation-Reduction Potential
    Male Infertility, 2020
    Co-Authors: Mohit Rana, Ashok Agarwal
    Abstract:

    Male infertility affects 15% of all couples in the world. As healthcare access continues to improve in the developing nation, the number of couples diagnosed with infertility is likely to increase. The current methods to determine male fertility were established by the World Health Organization (WHO) fifth edition guidelines that have several limitations. The main limitations are that they do not evaluate sperm functionality nor do they represent all the regions of the globe. The main aspect of functionality tests is to determine the sperm’s ability to fertilize the oocyte. When functional tests show an impairment in the ability of sperm to fertilize the oocyte, the most common pathologies associated are those mediated by oxidative stress (OS). While many OS pathologies are resolved by intracytoplasmic sperm injection, sperm DNA fragmentation (SDF) will decrease the success of pregnancy. SDF is predominately induced by OS and thus has spurred developments in assays that can determine OS in semen. The most recent assay, the MiOXSYS system, produces a quick and reliable measure of OS. Not only does Oxidation-Reduction Potential of semen correlate with sperm parameters, it is a cost-effective measure of OS. The MiOXSYS system has been rigorously validated by some investigators and has undergone global validation to become an established metric of OS-induced infertility.

  • multi center evaluation of Oxidation Reduction Potential by the mioxsys in males with abnormal semen
    Asian Journal of Andrology, 2019
    Co-Authors: Ashok Agarwal, Manesh Kumar Panner Selvam, Mohamed Arafa, Hiroshi Okada, Sheryl T Homa, Aideen P Killeen, Basak Balaban, Ramadan A Saleh, Abdullah Armagan, Shubhadeep Roychoudhury
    Abstract:

    According to the World Health Organization (WHO), oxidative stress (OS) is a significant contributor to male infertility. Seminal OS can be measured by a number of assays, all of which are either costly or time sensitive and/or require large semen volume and complex instrumentation. One less expensive alternative is to quantify the Oxidation-Reduction Potential (ORP) with the MiOXSYS. In this international multi-center study, we assessed whether ORP levels measured by the MiOXSYS could distinguish semen samples that fall within the 2010 WHO normal reference values from those that do not. Semen samples were collected from 2092 patients in 9 countries; ORP was normalized to sperm concentration (mV/106 sperm/ml). Only those samples with a concentration >1 × 106 sperm ml–1 were included. The results showed that 199 samples fell within the WHO normal reference range while the remaining 1893 samples did not meet one or more of the criteria. ORP was negatively correlated with all semen parameters (P

David Baror - One of the best experts on this subject based on the ideXlab platform.

  • Oxidation Reduction Potential as a biomarker for severity and acute outcome in traumatic brain injury
    Oxidative Medicine and Cellular Longevity, 2016
    Co-Authors: Kimberly B Bjugstad, Leonard T Rael, Denetta S Slone, Charles W Mains, Stewart Levy, Matthew M Carrick, David Baror
    Abstract:

    There are few reliable markers for assessing traumatic brain injury (TBI). Elevated levels of oxidative stress have been observed in TBI patients. We hypothesized that Oxidation-Reduction Potential (ORP) could be a potent biomarker in TBI. Two types of ORP were measured in patient plasma samples: the static state of oxidative stress (sORP) and capacity for induced oxidative stress (icORP). Differences in ORP values as a function of time after injury, severity, and hospital discharge were compared using ANOVAs with significance at . Logit regression analyses were used to predict acute outcome comparing ORP, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS). Antioxidant capacity (icORP) on day 4 was prognostic for acute outcomes (). An odds ratio of 4.08 was associated with poor acute outcome when icORP > 7.25 μC. IcORP was a better predictor than ISS, AIS, or GCS scores. sORP increased in those with the highest ISS values (). Based on these findings ORP is useful biomarker for severity and acute outcome in TBI patients. Changes in ORP values on day 4 after injury were the most prognostic, suggesting that patients’ response to brain injury over time is a factor that determines outcome.

  • assessment of oxidative stress in septic and obese patients using markers of Oxidation Reduction Potential
    in Vivo, 2015
    Co-Authors: Ypatios Spanidis, David Baror, Dimitrios Stagos, Nikolaos Goutzourelas, Anastasia S Kolyva, Charalambos Gogos, Dimitrios Kouretas
    Abstract:

    BACKGROUND/AIM The novel static (sORP) and capacity (cORP) Oxidation-Reduction Potential markers were examined for assessing oxidative stress in plasma of patients with sepsis. Moreover, the possible effect of obesity-induced oxidative stress on patients with sepsis was investigated. MATERIALS AND METHODS sORP and cORP markers, as well as the conventional oxidative stress biomarkers total antioxidant capacity (TAC), thiobarbituric acid-reactive substances (TBARS) and protein carbonyls (CARB), were assessed in plasma. RESULTS sORP marker was increased significantly in the sepsis group, while cORP was significantly lower compared to the control group, indicating oxidative stress. Furthermore, in patients with sepsis, TAC was significantly lower compared to control group. However, obesity had no effect on sORP, cORP and TAC in patients with sepsis, although it increased levels of CARB and TBARS. CONCLUSION The present results suggest, for the first time, that ORP markers could be used for assessing oxidative stress in patients with sepsis.

  • assessment of eccentric exercise induced oxidative stress using Oxidation Reduction Potential markers
    Oxidative Medicine and Cellular Longevity, 2015
    Co-Authors: Dimitrios Stagos, David Baror, Nikolaos Goutzourelas, Amaliamaria Ntontou, Ioannis Kafantaris, Chariklia K Deli, Athanasios Poulios, Athanasios Z Jamurtas, Dimitrios Kouretas
    Abstract:

    The aim of the present study was to investigate the use of static (sORP) and capacity ORP (cORP) Oxidation-Reduction Potential markers as measured by the RedoxSYS Diagnostic System in plasma, for assessing eccentric exercise-induced oxidative stress. Nineteen volunteers performed eccentric exercise with the knee extensors. Blood was collected before, immediately after exercise, and 24, 48, and 72 h after exercise. Moreover, common redox biomarkers were measured, which were protein carbonyls, thiobarbituric acid-reactive substances, total antioxidant capacity in plasma, and catalase activity and glutathione levels in erythrocytes. When the participants were examined as one group, there were not significant differences in any marker after exercise. However, in 11 participants there was a high increase in cORP after exercise, while in 8 participants there was a high decrease. Thus, the participants were divided in low cORP group exhibiting significant decrease in cORP after exercise and in high cORP group exhibiting significant increase. Moreover, only in the low cORP group there was a significant increase in lipid perOxidation after exercise suggesting induction of oxidative stress. The results suggested that high decreases in cORP values after exercise may indicate induction of oxidative stress by eccentric exercise, while high increases in cORP values after exercise may indicate no existence of oxidative stress.

  • injury severity and serum amyloid a correlate with plasma Oxidation Reduction Potential in multi trauma patients a retrospective analysis
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2009
    Co-Authors: Leonard T Rael, Raphael Baror, Denetta S Slone, Charles W Mains, Kristin Salottolo, Patrick J Offner, David Baror
    Abstract:

    Background In critical injury, the occurrence of increased oxidative stress or a reduced antioxidant status has been observed. The purpose of this study was to correlate the degree of oxidative stress, by measuring the Oxidation-Reduction Potential (ORP) of plasma in the critically injured, with injury severity and serum amyloid A (SAA) levels.

  • Oxidation Reduction Potential and paraoxonase arylesterase activity in trauma patients
    Biochemical and Biophysical Research Communications, 2007
    Co-Authors: Leonard T Rael, Raphael Baror, Rachel M Aumann, Denetta S Slone, Charles W Mains, David Baror
    Abstract:

    The amount of oxidative stress in severely traumatized patients is usually based on various individual parameters such as total antioxidants and lipid perOxidation. Serial measurements of plasma Oxidation-Reduction Potential (ORP) in severely traumatized patients as a simple mean of assessing overall oxidative stress is described. Serial whole blood samples were obtained from multi-trauma patients (N=39) and healthy individuals (N=10). Plasma ORP in multi-trauma patients increased during the first few days of hospitalization and approached normal ORP levels upon discharge. On the ORP maxima day (5.8 days+/-0.5 SEM), a statistically significant decrease (p<0.05) was observed for negative acute phase reactants such as plasma paraoxonase-arylesterase (PON-AE) activity and total plasma protein in comparison with admission plasma levels. Monitoring ORP could be a useful tool for assessing the degree of oxidative stress, inflammation, severity of injury, and Potential efficacy of treatment.

Leonard T Rael - One of the best experts on this subject based on the ideXlab platform.

  • Oxidation Reduction Potential as a biomarker for severity and acute outcome in traumatic brain injury
    Oxidative Medicine and Cellular Longevity, 2016
    Co-Authors: Kimberly B Bjugstad, Leonard T Rael, Denetta S Slone, Charles W Mains, Stewart Levy, Matthew M Carrick, David Baror
    Abstract:

    There are few reliable markers for assessing traumatic brain injury (TBI). Elevated levels of oxidative stress have been observed in TBI patients. We hypothesized that Oxidation-Reduction Potential (ORP) could be a potent biomarker in TBI. Two types of ORP were measured in patient plasma samples: the static state of oxidative stress (sORP) and capacity for induced oxidative stress (icORP). Differences in ORP values as a function of time after injury, severity, and hospital discharge were compared using ANOVAs with significance at . Logit regression analyses were used to predict acute outcome comparing ORP, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS). Antioxidant capacity (icORP) on day 4 was prognostic for acute outcomes (). An odds ratio of 4.08 was associated with poor acute outcome when icORP > 7.25 μC. IcORP was a better predictor than ISS, AIS, or GCS scores. sORP increased in those with the highest ISS values (). Based on these findings ORP is useful biomarker for severity and acute outcome in TBI patients. Changes in ORP values on day 4 after injury were the most prognostic, suggesting that patients’ response to brain injury over time is a factor that determines outcome.

  • injury severity and serum amyloid a correlate with plasma Oxidation Reduction Potential in multi trauma patients a retrospective analysis
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2009
    Co-Authors: Leonard T Rael, Raphael Baror, Denetta S Slone, Charles W Mains, Kristin Salottolo, Patrick J Offner, David Baror
    Abstract:

    Background In critical injury, the occurrence of increased oxidative stress or a reduced antioxidant status has been observed. The purpose of this study was to correlate the degree of oxidative stress, by measuring the Oxidation-Reduction Potential (ORP) of plasma in the critically injured, with injury severity and serum amyloid A (SAA) levels.

  • Oxidation Reduction Potential and paraoxonase arylesterase activity in trauma patients
    Biochemical and Biophysical Research Communications, 2007
    Co-Authors: Leonard T Rael, Raphael Baror, Rachel M Aumann, Denetta S Slone, Charles W Mains, David Baror
    Abstract:

    The amount of oxidative stress in severely traumatized patients is usually based on various individual parameters such as total antioxidants and lipid perOxidation. Serial measurements of plasma Oxidation-Reduction Potential (ORP) in severely traumatized patients as a simple mean of assessing overall oxidative stress is described. Serial whole blood samples were obtained from multi-trauma patients (N=39) and healthy individuals (N=10). Plasma ORP in multi-trauma patients increased during the first few days of hospitalization and approached normal ORP levels upon discharge. On the ORP maxima day (5.8 days+/-0.5 SEM), a statistically significant decrease (p<0.05) was observed for negative acute phase reactants such as plasma paraoxonase-arylesterase (PON-AE) activity and total plasma protein in comparison with admission plasma levels. Monitoring ORP could be a useful tool for assessing the degree of oxidative stress, inflammation, severity of injury, and Potential efficacy of treatment.

Ralf Henkel - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of seminal Oxidation Reduction Potential in male infertility
    Andrologia, 2021
    Co-Authors: Manesh Kumar Panner Selvam, Ashok Agarwal, Ralf Henkel, Renata Finelli
    Abstract:

    The role of oxidative stress in male infertility has been broadly recognised, and the search for a new marker to determine the redox environment in semen has gained considerable interest. Oxidation-Reduction Potential (ORP) or redox Potential, is a measure of the electron transfer from antioxidants to oxidants and provides information on the redox balance. In this review, the benefits of ORP as a new oxidative stress marker, the protocol for its evaluation and the importance of its measurement in the context of male infertility are discussed. In association with the standard semen analysis, seminal ORP has been analysed to evaluate semen quality and male fertility status. However, further studies are required to establish its use in assisted reproductive techniques (ART) practice.

  • Evaluation of seminal OxidationReduction Potential in male infertility
    Andrologia, 2020
    Co-Authors: Manesh Kumar Panner Selvam, Ashok Agarwal, Renata Finelli, Ralf Henkel
    Abstract:

    The role of oxidative stress in male infertility has been broadly recognised, and the search for a new marker to determine the redox environment in semen has gained considerable interest. Oxidation-Reduction Potential (ORP) or redox Potential, is a measure of the electron transfer from antioxidants to oxidants and provides information on the redox balance. In this review, the benefits of ORP as a new oxidative stress marker, the protocol for its evaluation and the importance of its measurement in the context of male infertility are discussed. In association with the standard semen analysis, seminal ORP has been analysed to evaluate semen quality and male fertility status. However, further studies are required to establish its use in assisted reproductive techniques (ART) practice.

  • seminal Oxidation Reduction Potential levels are not influenced by the presence of leucocytospermia
    Andrologia, 2020
    Co-Authors: Mohamed Arafa, Ashok Agarwal, Ralf Henkel, Renata Finelli, Ahmad Majzoub, Kathy Amy Robert, Haitham Elbardisi
    Abstract:

    Oxidative stress (OS) is characterised by an excessive amount of reactive oxygen species (ROS) which negatively affect sperm functions. In this study, the influence of leucocytes on seminal Oxidation-Reduction Potential (ORP) and sperm DNA fragmentation (SDF) was investigated in 1,068 men. Seminal leucocyte concentration did not correlate with SDF, unadjusted ORP, ORP normalised for sperm concentration (sORP), ORP normalised for total motile sperm concentration (motORP) or total motile sperm count (TMSC-ORP). Although receiver operator characteristic (ROC) curve analyses show that leucocytospermia does not predict high sORP values (>1.34 mV/106 spermatozoa/ml), the motORP (AUC: 0.666) and TMSC-ORP (AUC: 0.683) predict the rate of leucocytospermia significantly (p = .0195 and p = .0085 respectively). Moreover, SDF can significantly predict leucocytospermia (AUC: 0.679; p = .011) and vice versa (AUC: 0.657, p = .0298). Our data confirm the association between OS and SDF. In conclusion, motORP and TMSC-ORP may be better predictive factors of leucocytospermia, probably because sperm motility, included in motORP and TMSC-ORP calculation, is the first seminal parameter to be affected by OS. Although all these parameters are indicative of OS, ORP values, SDF and leucocytospermia should be considered independently for the evaluation of redox seminal status, as they probe distinct seminal features.

  • correlation of Oxidation Reduction Potential with hormones semen parameters and testicular volume
    Andrologia, 2019
    Co-Authors: Mohamed Arafa, Ashok Agarwal, Ralf Henkel, Ahmad Majzoub, Haitham Elbardisi
    Abstract:

    Seminal oxidative stress (OS) is a major cause of male factor infertility and can be measured as Oxidation-Reduction Potential (ORP). Studies showed significant negative relationships of ORP with sperm count, motility or DNA integrity. Since these parameters are also positively or negatively associated with reproductive hormones follicle-stimulating hormone (FSH), luteinising hormone (LH), testosterone, testicular volume and the occurrence of varicocele, it is important to understand the mechanistic relationship between ORP and hormonal and/or testicular parameters. Therefore, we studied the relationship between ORP levels, standard hormone profiles and testicular volume in infertile men with and without varicocele. Results show a highly significant negative relationship of ORP with testicular volume and significantly positive correlations with FSH and LH. Yet, when adding varicocele as covariate, the relationship with FSH/LH became nonsignificant. Contrary, the presence of varicocele had only a contributing influence on the association of ORP with the testis volume. No association was found with estradiol. We propose that since OS causes degeneration of Sertoli cell with testicular shrinkage, such negative effect would result in a negative feedback on the hypothalamus with less inhibin secretion. This may result in increased secretion of LH and FSH. Thus, systemic and/or local OS may be responsible for smaller testis volumes.

  • Calibration of redox Potential in sperm wash media and evaluation of Oxidation-Reduction Potential values in various assisted reproductive technology culture media using MiOXSYS system.
    Andrology, 2018
    Co-Authors: M. Panner Selvam, Ralf Henkel, Rajan Sharma, Ashok Agarwal
    Abstract:

    Oxidation-Reduction Potential describes the balance between the oxidants and antioxidants in fluids including semen. Various artificial culture media are used in andrology and IVF laboratories for sperm preparation and to support the development of fertilized oocytes under in vitro conditions. The composition and conditions of these media are vital for optimal functioning of the gametes. Currently, there are no data on the status of redox Potential of sperm processing and assisted reproduction media. The purpose of this study was to compare the Oxidation-Reduction Potential values of the different media and to calibrate the Oxidation-Reduction Potential values of the sperm wash medium using oxidative stress inducer cumene hydroperoxide and antioxidant ascorbic acid. Redox Potential was measured in 10 different media ranging from sperm wash media, freezing media and assisted reproductive technology one-step medium to sequential media. Oxidation-Reduction Potential values of the sequential culture medium and one-step culture medium were lower and significantly different (p < 0.05) from the sperm wash media. Calibration of the sperm wash media using the oxidant cumene hydroperoxide and antioxidant ascorbic acid demonstrated that Oxidation-Reduction Potential and the concentration of oxidant or antioxidant are logarithmically dependent. This study highlights the importance of calibrating the Oxidation-Reduction Potential levels of the sperm wash media in order to utilize it as a reference value to identify the physiological range of Oxidation-Reduction Potential that does not have any adverse effect on normal physiological sperm function.

Denetta S Slone - One of the best experts on this subject based on the ideXlab platform.

  • Oxidation Reduction Potential as a biomarker for severity and acute outcome in traumatic brain injury
    Oxidative Medicine and Cellular Longevity, 2016
    Co-Authors: Kimberly B Bjugstad, Leonard T Rael, Denetta S Slone, Charles W Mains, Stewart Levy, Matthew M Carrick, David Baror
    Abstract:

    There are few reliable markers for assessing traumatic brain injury (TBI). Elevated levels of oxidative stress have been observed in TBI patients. We hypothesized that Oxidation-Reduction Potential (ORP) could be a potent biomarker in TBI. Two types of ORP were measured in patient plasma samples: the static state of oxidative stress (sORP) and capacity for induced oxidative stress (icORP). Differences in ORP values as a function of time after injury, severity, and hospital discharge were compared using ANOVAs with significance at . Logit regression analyses were used to predict acute outcome comparing ORP, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), and Glasgow Coma Scale (GCS). Antioxidant capacity (icORP) on day 4 was prognostic for acute outcomes (). An odds ratio of 4.08 was associated with poor acute outcome when icORP > 7.25 μC. IcORP was a better predictor than ISS, AIS, or GCS scores. sORP increased in those with the highest ISS values (). Based on these findings ORP is useful biomarker for severity and acute outcome in TBI patients. Changes in ORP values on day 4 after injury were the most prognostic, suggesting that patients’ response to brain injury over time is a factor that determines outcome.

  • injury severity and serum amyloid a correlate with plasma Oxidation Reduction Potential in multi trauma patients a retrospective analysis
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine, 2009
    Co-Authors: Leonard T Rael, Raphael Baror, Denetta S Slone, Charles W Mains, Kristin Salottolo, Patrick J Offner, David Baror
    Abstract:

    Background In critical injury, the occurrence of increased oxidative stress or a reduced antioxidant status has been observed. The purpose of this study was to correlate the degree of oxidative stress, by measuring the Oxidation-Reduction Potential (ORP) of plasma in the critically injured, with injury severity and serum amyloid A (SAA) levels.

  • Oxidation Reduction Potential and paraoxonase arylesterase activity in trauma patients
    Biochemical and Biophysical Research Communications, 2007
    Co-Authors: Leonard T Rael, Raphael Baror, Rachel M Aumann, Denetta S Slone, Charles W Mains, David Baror
    Abstract:

    The amount of oxidative stress in severely traumatized patients is usually based on various individual parameters such as total antioxidants and lipid perOxidation. Serial measurements of plasma Oxidation-Reduction Potential (ORP) in severely traumatized patients as a simple mean of assessing overall oxidative stress is described. Serial whole blood samples were obtained from multi-trauma patients (N=39) and healthy individuals (N=10). Plasma ORP in multi-trauma patients increased during the first few days of hospitalization and approached normal ORP levels upon discharge. On the ORP maxima day (5.8 days+/-0.5 SEM), a statistically significant decrease (p<0.05) was observed for negative acute phase reactants such as plasma paraoxonase-arylesterase (PON-AE) activity and total plasma protein in comparison with admission plasma levels. Monitoring ORP could be a useful tool for assessing the degree of oxidative stress, inflammation, severity of injury, and Potential efficacy of treatment.