Intravenous Administration Of Vitamin Research Articles

Effect of Perioperative Oral Vitamin C Supplementation on In-Hospital Postoperative Medication Costs for Cardiac Surgery Patients: A Prospective, Single-Centre, Randomised Clinical Trial.

Due to its antioxidant properties, vitamin C might be a promising and effective strategy for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. This study was aimed at evaluating whether vitamin C supplementation is effective in reducing the cost of in-hospital postoperative medication used for patients undergoing coronary artery bypass (CABG) or valve surgery (±CABG). The primary goal of this study was to evaluate the impact of perioperative vitamin C supplementation in patients undergoing cardiac surgery on in-hospital postoperative medication costs, while secondary endpoints were the effects on length of stay (LOS) in both the intensive care unit (ICU) and the hospital, and the incidence of POAF. From November 2018 to January 2021, 253 patients planned for CABG or valve surgery (±CABG) in AZ Maria Middelares, Ghent, Belgium, and who met the inclusion criteria (≥18 years of age, all having cardiac sinus rhythm, and who provided written informed consent) were randomised into a placebo group or vitamin C group. The medication was administered orally (1g twice daily), starting from 5 days preoperatively until 10 days postoperatively. The medication used, LOS in the hospital/ICU, and development of clinically relevant POAF in the ICU were registered. Mean medication costs were €264.6±98.1 for patients in the vitamin C group and €294.9±267.3 for patients in the placebo group. When stratifying according to the type of surgery (CABG or valve surgery [±CABG]), these costs did not significantly differ. There was no significant difference in LOS or the incidence of clinically relevant POAF. Our data did not identify any short-term financial impact on postoperative medication costs after oral perioperative vitamin C supplementation (1g twice daily) for patients undergoing a CABG procedure or valve surgery (±CABG). No effect was found on the LOS or the incidence of clinically relevant POAF. Potential effects in the longer term, after intravenous administration of vitamin C or in other types of (cardiac) surgery, are still to be investigated. NCT03592680.

Intravenous vitamin C use and risk of severity and mortality in COVID-19: A systematic review and meta-analysis.

The administration of intravenous vitamin C (IV‐VC) in treating patients with coronavirus disease 2019 (COVID‐19) is still highly controversial. There have been no previous studies on the effect of IV‐VC on the severity and mortality of COVID‐19. Hence, we conducted a systematic review and meta‐analysis to compare the disease severity and mortality in patients with COVID‐19 who promptly received IV‐VC treatment vs those who did not.We performed a comprehensive systematic search of seven health science databases, including PubMed, Embase, Cochrane Library, MEDLINE, Web of Science, China National Knowledge Infrastructure, and Wanfang Data, up to June 23, 2021. We identified a total of seven related articles, which were included in this study.This meta‐analysis showed that IV‐VC treatment did not affect disease severity compared with placebo treatment or usual care (odds ratio [OR], 0.70; 95% CI, 0.45 to 1.07; P = 0.10). In addition, no statistically significant difference in mortality was observed between patients who received IV‐VC treatment and those who did not (OR, 0.64; 95% CI, 0.41 to 1.00; P = 0.05). Moreover, the adjusted meta‐analysis revealed that the use of IV‐VC did not influence disease severity (OR, 0.67; 95% CI, 0.34 to 1.31; P = 0.242) or mortality (OR, 1.02; 95% CI, 0.75 to 1.40; P = 0.877) in comparison with a control group.The results of this meta‐analysis demonstrated that short‐term IV‐VC treatment did not reduce the risk of severity and mortality in patients with COVID‐19.

Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence.

Severe respiratory infections are characterized by elevated inflammation and generation of reactive oxygen species (ROS) which may lead to a decrease in antioxidants such as vitamin C and a higher requirement for the vitamin. Administration of intravenous vitamin C to patients with pneumonia and sepsis appears to decrease the severity of the disease and potentially improve survival rate. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes pneumonia, sepsis and acute respiratory distress syndrome (ARDS) in severe cases, and is referred to as coronavirus disease 2019 (COVID-19). Patients with COVID-19 infection also appear to have depleted vitamin C status and require additional supplementation of vitamin C during the acute phase of the disease. To date there have been 12 vitamin C and COVID-19 trials published, including five randomised controlled trials (RCTs) and seven retrospective cohort studies. The current level of evidence from the RCTs suggests that intravenous vitamin C intervention may improve oxygenation parameters, reduce inflammatory markers, decrease days in hospital and reduce mortality, particularly in the more severely ill patients. High doses of oral vitamin C supplementation may also improve the rate of recovery in less severe cases. No adverse events have been reported in published vitamin C clinical trials in COVID-19 patients. Upcoming findings from larger RCTs will provide additional evidence on vitamin supplementation in COVID-19 patients.

Intravenous Administration of Vitamin B Complex Improves Renal Recovery in Patients with AKI

Intravenous Administration of Vitamin B Complex Improves Renal Recovery in Patients with AKI

Management of surgical complications following prolonged warfarin therapy in a general surgical hospital

To analyze an effectiveness of algorithm for complex treatment of patients with surgical complications of prolonged warfarin therapy in a general surgical hospital. The study included 138 patients with surgical complications of prolonged warfarin therapy. All patients received warfarin for at least 6 months (49.5% of patients - over 5 years). Warfarin therapy was indicated for deep vein thrombosis in 54 patients and various cardiac diseases in 84 patients. Examination included clinical and instrumental survey, laboratory tests and coagulation tests - thromboelastography (TEG) and thrombodynamics test (TT). Recurrent VTEC occurred in 24 out of 138 patients, hemorrhagic complications - in 114 patients. Therapeutic management was applied in 111 patients, 27 ones underwent surgery (emergency treatment - 25 patients, after two days - 2 patients). Ten patients underwent endoscopic hemostasis, two patients - ultrasound-assisted percutaneous drainage of hematoma. Recurrent VTECs were caused by inadequate laboratory control and violations of warfarin therapy. Most of these patients underwent therapeutic management (only 3 patients required surgery for life-threatening flotation in great veins). Treatment of 114 patients with hemorrhagic complications of prolonged warfarin therapy depended on features of bleeding and severity of warfarin-induced coagulopathy. Depending on these factors, warfarin was discontinued and intravenous administration of vitamin K / FFP / prothrombin complex concentrate was applied. This approach ensured successful therapeutic measures in 90 patients of this group. Twenty-four patients underwent surgery after correction of hemostatic disorders. TT was characterized by high efficiency in analysis of thrombotic predisposition and prediction of the risk of VTEC. TEG was valuable for assessment of warfarin-induced coagulopathy and treatment of patients with hemorrhagic complications of prolonged warfarin therapy. The developed clinical and diagnostic algorithm for management of hemorrhagic complications of prolonged warfarin therapy ensures positive clinical results even in a general surgical hospital.

Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone (The Metabolic Resuscitation Protocol) on Early Weaning from Vasopressors in Patients with Septic Shock. A Descriptive Case Series Study

Objectives: The aim of this study was to assess the efficacy of intravenous vitamin C, hydrocortisone, and thiamine in early weaning (within 48 hours) from vasopressor support in patients with septic shock. We also aimed to assess mortality and intensive care unit (ICU) stay.Study Design: We conducted a descriptive case series study of 50 patients with septic shock who were admitted in the ICU of the Combined Military Hospital Rawalpindi in Pakistan from August 2017 until April 2018.Materials and Methods: The study included men and women (16 to 80 years of age) who were admitted to the ICU with septic shock. Data were analysed using the IBM Statistical Package for Social Sciences (SPSS), version 18.0 (IBM Corp., Armonk, NY, USA). Inferential analysis was done with the help of simple and multivariate binary logistic regression that generated unadjusted and adjusted odds ratios (OR), respectively.Results: Of the 50 patients, 56% (N = 28) were male with a mean age of the respondents being 46.7 ± 18.4. Eighty-four percent were successfully weaned off vasopressors within 48 hours. Median days in the ICU were reported as 8.3 (interquartile range (IQR) = 5). Primary bacteremia (34%) was the most reported cause of ICU admission. The most common vasopressor was norepinephrine and its mean dose was 21.6 ± 10.7 microgram/min. The ICU mortality was observed at 52% (N = 26). Unadjusted OR showed a dose of norepinephrine, Sequential Organ Failure Assessment (SOFA) score, plasma procalcitonin, and plasma lactate to be significant predictors (p-value < 0.05), while the adjusted odds ratio (AOR) showed only a dose of norepinephrine to be a statistically significant predictor (AOR = 0.804, 95% CI = 0.674 - 0.960; p-value = 0.016).Conclusion: The administration of intravenous vitamin C, hydrocortisone, and thiamine to patients with septic shock was successful in early weaning from vasopressors. There was also a reduction in procalcitonin and lactate levels, as well as the SOFA score. Further trials are needed to determine whether the metabolic resuscitation protocol can become part of the treatment for septic shock.

Vitamin C alone does not improve treatment outcomes in mechanically ventilated patients with severe sepsis or septic shock: a retrospective cohort study.

Vitamin C has shown several beneficial effects on sepsis in preclinical studies. However, clinical data supporting these reports are scarce. This study aimed to evaluate whether adjunctive intravenous vitamin C therapy could reduce hospital mortality in patients with severe sepsis or septic shock requiring mechanical ventilation. For this retrospective cohort study, consecutive medical ICU patients with severe sepsis or septic shock requiring mechanical ventilation were included. The study patients were classified into the vitamin C or control groups depending on the administration of intravenous vitamin C (2 g every 8 hours). The primary outcome was hospital mortality. Thirty-five patients in the vitamin C group and 40 patients in the control group were included. The two groups were comparable in regards to the baseline characteristics at ICU admission. The hospital mortality was 46% (16 of 35 patients) in the vitamin C group and 40% (16 of 40 patients) in the control group, showing a statistically nonsignificant difference (P=0.62). The mortality at 90 days after ICU admission (60% vs. 48%) did not significantly differ between groups. The median time to shock reversal was 3 days [interquartile range (IQR), 2 to 5 days] in both groups. The changes in the Sepsis-related Organ Failure Assessment (SOFA) scores during the first 4 ICU days were -1.4±3.3 and -1.4±3.0 in the vitamin C and control groups, respectively. Adjunctive intravenous vitamin C therapy alone did not reduce hospital mortality in mechanically ventilated patients with severe sepsis or septic shock.

A Meta-analysis of Randomized Control Trials: The Impact of Vitamin C Supplementation on Serum CRP and Serum hs-CRP Concentrations.

The present meta-analysis was designed to assess the effects of vitamin C supplementation on serum C-reactive Protein (CRP) levels. We conducted a comprehensive systematic search of the literature in Scopus, PubMed and Google Scholar until May 2018. The pooled Weighted Mean Difference (WMD) and its 95% Confidence Interval (CI) in baseline and at the end of the trial were calculated to assess the net change in serum CRP by using random-effects model. The heterogeneity was assessed by I2 test. Combined and stratified analyses were used in the metaanalysis. From 306 articles found and screened in our initial search, 12 studies were included with 446 participants in supplementation groups and 447 in control groups. The pooled effect size analysis showed a significant reducing effect of vitamin C supplementation on circulating CRP level (-0.23 mg/L, 95% CI, -0.44, -0.03, p=0.02), with a significant heterogeneity effect across the studies involved. Subgroup analyses showed that vitamin C supplementation significantly lowered CRP among trials. The most significant effect was found 1) on hs- CRP as the representative inflammatory marker (-0.43 mg/L, 95% CI -0.76, -0.1) 2) in subjects with a baseline CRP≥3 (-1.48 mg/L, 95% CI -2.84, -0.11) 3) in subjects under <60 years old of age (-0.23 mg/L, 95% CI -0.44,- 0.01) 4) or using intravenous administration of vitamin C (-0.89 mg/L, 95% CI -1.49,-0.3). The present meta-analysis shows that vitamin C supplementation reduces serum CRP level, particularly in younger subjects, with higher CRP baseline level, at a lower dosage and intravenous administration.

Vitamin C supplementation in the critically ill: A systematic review and meta-analysis.

Background:Low plasma levels of vitamin C are associated with adverse outcomes, including increased mortality, in critically ill patients. Several trials have suggested that the administration of intravenous vitamin C in this setting may have beneficial effects, such as reducing the incidence of organ failure and improving survival. However, these studies have generally involved combination therapies consisting of vitamin C along with other antioxidants, confounding the effects of vitamin C alone. The primary objective of this meta-analysis is to investigate the effects of isolated intravenous supplementation of vitamin C in adults with critical illness.Methods:A database search was conducted for studies on the use of intravenous vitamin C in adult patients with critical illness. The primary outcome assessed was mortality at the longest follow-up time available. Secondary outcomes were the duration of mechanical ventilation, duration of vasopressor support, fluid requirements, and urine output in the first 24 h of intensive care unit admission.Results:Five studies (four randomized controlled trials and one retrospective review) enrolling a total of 142 patients were included in this meta-analysis. Compared with controls, the administration of intravenous vitamin C was associated with a decreased need for vasopressor support (standardized mean difference −0.71; 95% confidence interval (−1.16 to −0.26); p = 0.002) and decreased duration of mechanical ventilation (standardized mean difference −0.5; 95% confidence interval (−0.93 to −0.06); p = 0.03), but no difference was found in mortality (odds ratio 0.76; 95% confidence interval (0.27 to 2.16); p = 0.6). Trends were also noted toward decreased fluid requirements and increased urine output. No adverse effects were reported.Conclusion:The administration of intravenous vitamin C may lead to vasopressor sparing effects and a reduced need for mechanical ventilation in the critically ill, without affecting overall mortality. However, these results should be interpreted in light of the limitations of the primary literature and should serve as a preview of upcoming trials in this area.

Intravenous vitamin b – complex and ferrous dextrane in malaria induced anemia: a single center prospective study

Background: In sub - Saharan Africa countries Plasmodium falciparum malaria is the most important parasitic disease. Accordingly, malaria induced anemia is one of the main public health burden. Treatment for anemia depends on severity and cause. In severe cases a blood transfusion may be necessary. Blood supplies in Africa are not able to meet the demand and this often leads to high maternal and child mortality rates in the continent. Also, it has been estimated that 5 – 10% of HIV transmission in Africa is brought by contaminated blood transfusions. Aim of the Study: Was to explore the hemoglobin increase, clinical benefits and safety of intravenous administration of vitamin B – complex and ferrous dextrane combination in patients with acute moderate to severe malaria induced anemia in rural African setting. Methods: With the hypothesis of obtaining a hemoglobin increase of ≥ 1g/dl in at least 50% of patients, 89 patients were included in the study after diagnosis of malaria and moderate to severe anemia (Hb: 6 – 10 g/dl) was confirmed. Patients were treated twice daily for three consecutive days. Statistics: Analysis were undertaken on perprotocol basis. Wilcoxon rank test was used to compare the average hemoglobin value at baseline and end of treatment course. Correlation between patients’ age and average hemoglobin increase was assessed by Spearman’s rank correlation test. All tests were two-tailed and significance was reported at the 5% level. Results: 49 patients (55%) showed a treatment response, 21 (23,6%) improved clinically and 19 (21,3%) failed to respond to the treatment. The difference was found statistically significant. Average hemoglobin concentration at the end of treatment was found higher than baseline and the difference was considered statistically very significant (9 g/dl vs. 8 g/dl; p &lt; 0,0001). Conclusion: The results of the present study show that this treatment should be considered a useful first line intervention in healthcare settings, especially in rural sub Saharan Africa where blood transfusion is a hardly available option.

Liposomal-encapsulated Ascorbic Acid: Influence on Vitamin C Bioavailability and Capacity to Protect Against Ischemia-Reperfusion Injury.

Intravenous administration of vitamin C has been shown to decrease oxidative stress and, in some instances, improve physiological function in adult humans. Oral vitamin C administration is typically less effective than intravenous, due in part to inferior vitamin C bioavailability. The purpose of this study was to determine the efficacy of oral delivery of vitamin C encapsulated in liposomes. On 4 separate randomly ordered occasions, 11 men and women were administered an oral placebo, or 4 g of vitamin C via oral, oral liposomal, or intravenous delivery. The data indicate that oral delivery of 4 g of vitamin C encapsulated in liposomes (1) produces circulating concentrations of vitamin C that are greater than unencapsulated oral but less than intravenous administration and (2) provides protection from ischemia–reperfusion-mediated oxidative stress that is similar to the protection provided by unencapsulated oral and intravenous administrations.

Ascorbic Acid Supplementation: Influence of Delivery Method on Vitamin C Bioavailability and Capacity to Protect Against Ischemia‐Reperfusion Injury

Intravenous administration of vitamin C has been shown to decrease oxidative stress and, in some instances, improve physiological function in adult humans. Oral vitamin C administration is typically less effective, due in part to decreased vitamin C bioavailability. The purpose of this study was to determine the efficacy of oral delivery of vitamin C encapsulated in liposomes. On 4 separate occasions, occurring in random order, 11 obese adults (age: 53 ± 2 years; body mass index: 34.1 ± 1.0 kg/m2 (mean ± SE)) were administered an oral placebo, or 4 g of vitamin C via: oral, oral liposomal, or intravenous delivery. The area under the plasma vitamin C concentration curve, determined over 4 hours, was greatest (P &lt; 0.001) following intravenous administration (57.0 ± 6.9 (mg/dL)·h). Liposomal vitamin C delivery (10.3 ± 0.9) evoked a greater (P = 0.002) area under the curve than oral (7.6 ± 0.4) that in turn was greater (P &lt; 0.001) than placebo (3.1 ± 0.4). Forearm ischemia‐reperfusion (20 minutes of occlusion) increased circulating thiobarbituric acid reactive substances, a marker of oxidative stress, 40 minutes post‐reperfusion (P &lt; 0.03); this increase was prevented by all of the vitamin C treatments (P &gt; 0.05). These data suggest that oral delivery of vitamin C encapsulated in liposomes: 1) produces circulating concentrations of vitamin C that are greater than traditional oral administration; and, 2) provides protection from ischemia‐reperfusion that is similar to the protection provided by intravenous administration.Support: Empirical Labs

Vitamin K-induced anaphylaxis

Vitamin K is a naturally-occurring vitamin used to treat certain coagulation disorders. Despite its frequent use, vitamin K causes allergic reactions very rarely. We report a case of anaphylaxis due to vitamin K (phytonadione) that occurred in a 20-year-old man who has undergone hemorrhoid bleeding. The patient developed immediate whole body urticaria, itching sensation, dyspnea and marked hypotension about 2 minutes after the intravenous administration of vitamin K (phytonadione) and tranexamic acid for the purpose of bleeding control. Skin prick test was performed with vitamin K and tranexamic acid. Vitamin K showed positive response in skin prick test, while tranexamic acid showed negative response in skin prick test and challenge test. To our knowledge, it is the first case report of vitamin K-induced anaphylaxis that is proven with skin test. This case suggests that vitamin K can elicit anaphylaxis and skin test may be helpful in the diagnosis of a suspected allergic response to vitamin K. (Allergy Asthma Respir Dis 2014;2:146-149)

Intracranial Hemorrhage Associated With Vitamin K–deficiency Bleeding in Patients With Biliary Atresia

The prophylactic oral administration of vitamin K to newborns has markedly reduced the incidence of vitamin K deficiency (VKD); however, intracranial hemorrhage (ICH) is still one of the complications found in biliary atresia (BA) patients and is associated with VKD bleeding. Therefore, we aimed to investigate the incidence and long-term outcome of ICH in patients with BA who previously received prophylactic vitamin K during the neonatal period. Eighty-eight consecutive infants with BA were treated and followed up at Kyushu University Hospital from 1979 to 2009. The clinical records and imaging study results were retrospectively reviewed in the infants with BA who presented with ICH. ICH occurred in 7.95% of patients with BA. The onset of ICH occurred at 47 to 76 days after birth, before the patients underwent surgery for BA (9-37 days after the onset of ICH). Coagulopathy was found upon admission in all of the cases with available data and improved after intravenous administration of vitamin K. A craniotomy was required in 2 cases before the surgery for BA. During the 22 to 278 months of follow-up, some neurologic sequelae persisted in 5 of 7 cases. Follow-up head computed tomography scans showed a low-density area in the left hemisphere in 5 cases. Although vitamin K prophylaxis had been given during the neonatal period, ICH-associated VKD bleeding was still found in 7.95% of patients with BA. Persistent neurologic sequelae were found in 5 of 7 cases, with low-density area in the left hemisphere.

Intravenous administration of vitamin K as an effective treatment for a patient with systemic hemorrhage: a case report

症例は61歳, 男性. 胃がんの診断で胃全摘術を施行されたのち, リンパ節転移と骨転移で再発し, 両側尿管閉塞による慢性腎不全を併発したため緩和ケア病棟へ紹介されて転院となった. 遷延する尿路感染症に対して抗生剤点滴を行い改善がみられたが, その後, 食事摂取量が減少し, 血尿が出現し, さらに口腔内にも出血が認められるようになった. PT, APTTは測定不能と延長していたが, 血小板, フィブリノーゲン, FDPは正常でDICは否定された. 血清のPIVKA-IIが著明高値, ビタミンKは低値であり, ビタミンKの投与にてPT, APTT, 出血症状の改善を認めた. 本症例では, 食欲低下と抗生剤投与によりビタミンK欠乏が起こり, その結果, 出血症状が出現したと考えられる. 進行がん患者を対象とする緩和ケア領域では, 経口摂取の低下や抗生剤使用などのためビタミンKの欠乏が生じやすく, 出血症状がビタミンK欠乏症と終末期DICとの鑑別が必要な場合もあり, 注意が必要と考えられた.

Cantharidin patches and intravenous administration of vitamin C in the concomitant treatment of herpes zoster: a case report

Cantharidin patches and intravenous administration of vitamin C in the concomitant treatment of herpes zoster: a case report

Warfarin-Induced Sublingual Hematoma Mimicking Ludwig Angina: Conservative Management of a Potentially Life-Threatening Condition

Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

Anticoagulant-Associated Intracerebral Hemorrhage

The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled during the 1990 s, probably due to increased warfarin use for the treatment of atrial fibrillation. Anticoagulant-associated intracerebral hemorrhage now accounts for nearly 20% of all intracranial hemorrhage (ICH). Among patients using warfarin for atrial fibrillation, the annual risk of ICH in trials is 0.3 to 1.0%. Predictors of potential anticoagulant-associated hemorrhage are increasing age, prior ischemic stroke, hypertension, leukoaraiosis, the early period of warfarin use, higher intensity anticoagulation, and antiplatelet use in addition to anticoagulation. Compared with other intracranial hemorrhage patients, anticoagulated patients have a greater risk of hematoma expansion, subsequent clinical deterioration and death, necessitating vigorous reversal of their coagulopathy. Recommended methods of warfarin reversal are administration of intravenous vitamin K and either prothrombin complex concentrates or fresh frozen plasma. Reversal of unfractionated heparin is accomplished with intravenous protamine sulfate. Surgical treatment of intracranial hemorrhage may be life saving in select cases, but has not reduced morbidity or mortality in large randomized trials.

Prevention of steroid-induced osteonecrosis by intravenous administration of vitamin E in a rabbit model

BackgroundWe focused on vitamins with marked antioxidant potency to see whether their use might prevent the development of steroid-induced osteonecrosis. MethodsFifteen Japanese white rabbits weighing about 3.5 kg were injected once into the right gluteal muscle with methylpred-nisolone (MPSL) 40 mg/kg (S group). In addition, 10 other rabbits received consecutive daily intravenous injections of vitamin E 50 mg/kg, starting from the day of MPSL administration (E group). All animals were killed 2 weeks after MPSL administration, and femurs were extracted and stained with H&E. Blood levels of reduced glutathione (GSH) were also measured. ResultsIn the S group the osteonecrosis development rate was 93%, in contrast to 0% in the E group (P < 0.01). Also, GSH levels in the S group abruptly decreased from the first day after MPSL administration, whereas in the E group, the decline in GSH levels was significantly suppressed on days 1 and 3 after MPSL administration (P < 0.05). ConclusionsVitamin E administration significantly inhibited steroid-induced oxidative stress. The results of this study suggest that the administration of vitamin E may be a novel and simple method to prevent the development of steroid-induced osteonecrosis.

Synergistic potentiation of D-fraction with vitamin C as possible alternative approach for cancer therapy

Maitake D-fraction or PDF is the bioactive extract of maitake mushroom (Grifola frondosa) and its active constituent is the protein-bound polysaccharide (proteoglucan), or more specifically known as beta-glucan. PDF has been extensively studied and a number of its medicinal potentials/properties have been unveiled and demonstrated. Those include various physiological benefits ranging from immunomodulatory and antitumor activities to treatment for hypertension, diabetes, hypercholesterolemia, viral infections (hepatitis B and human immunodeficiency virus), and obesity. Particularly, two major biological activities of PDF, immunomodulatory and antitumor activities, have been the main target for scientific and clinical research. To demonstrate and confirm such biological activities, numerous studies have been performed in vitro and in vivo or in clinical settings. These studies showed that PDF was indeed capable of modulating immunologic and hematologic parameters, inhibiting or regressing the cancer cell growth, and even improving quality of life of cancer patients. Synergistic potentiation of PDF with vitamin C demonstrated in vitro is rather interesting and may have clinical implication, because such combination therapy appears to help improve the efficacy of currently ongoing cancer therapies. Recently, intravenous administration of vitamin C has been often used to increase its physiological concentration and this useful procedure may further make this combination therapy feasible. Therefore, PDF may have great potential, either being used solely or combined with other agents, for cancer therapy. Such relevant and detailed studies will be described and discussed herein with a special focus on the combination of PDF and vitamin C as a viable therapeutic option.