Calcium Gluconate Solution Research Articles

The Application of Regional Citrate Anticoagulation in Protein A Immunoadsorption: A Single-Center Retrospective Cohort Study

Introduction: Protein A immunoadsorption (IA) is proving to be an effective treatment method for autoimmune diseases and other disorders. Regional citrate anticoagulation (RCA) prevents clotting in extracorporeal circuits without increasing hemorrhage risk in high bleeding risk patients, but there are no specific guidelines for its application in IA. We aimed to evaluate the safety and adverse effects of RCA used in IA therapy. Methods: We conducted a retrospective cohort study of forty-five RCA-IA sessions in 14 HLA-incompatible kidney transplant recipients with focus on the safety and adverse effects of RCA in IA. The extracorporeal circuit was equipped with 4% trisodium citrate solution as an anticoagulant and 10% calcium gluconate solution to compensate for calcium loss. The adverse events, including coagulation and blood biochemical indexes, especially calcium level, were recorded. Results: Our study found that 93.33% of the sessions were without circuit clotting or other significant complications. A slight decrease in fibrinogen level was observed, but without significant variations in other coagulation indexes or platelet count. There was a slight elevation in the potential of hydrogen, bicarbonate, and base excess after 2 h and 6 h posttreatment relative to prior treatment, but these returned to normal levels within 24 h posttreatment. Conclusion: RCA is a feasible, effective, and safe anticoagulation option for IA treatment in HLA-incompatible kidney transplant recipients. Electrolyte disturbances, especially alkalosis, hypocalcemia, hypomagnesemia, and fluid status, should be closely monitored and managed.

A randomized study comparing the effect of platelet-rich plasma and platelet-poor plasma for the treatment of plantar fasciitis

Objective: To verify the effectiveness of therapy with platelet-rich plasma (PRP) in patients with plantar fasciitis, this prospective, longitudinal, double-blind study was carried out. Methodology: Twenty-three participants with chronic plantar fasciitis aged > 20 years, already treated with conventional methods were included. Participants were randomly divided into platelet-poor plasma (PPP) and platelet-rich plasma (PRP) groups. Double centrifugation was carried out to prepare the platelets samples and two millilitres of PPP (supernatant fraction) or PRP (sediment fraction) were mixed with 1mL of 2% calcium gluconate solution and injected in the plantar fascia, as a single dose. A follow-up at 15 days and then every 60 days up to 180 days of application was carried out and a visual analogue scale (VAS) for pain assessment and the quality-of-life scale validated by the American Orthopedic Foot and Ankle Society (AOFAS) were used to measure the outcomes. Results: A reduction in pain (VAS 8 to 4), in both groups, was seen in the first 15 days and remained up to the 6th month after the application of plasmas, however, no difference was observed between the groups. No significant improvement was observed in the quality of life of the patients. Conclusion: PPP or PRP were able to reduce the VAS, but the presence of platelets did not have a role in the pain relief. Other factors in the plasma may play a role in reducing the pain caused by plantar fasciitis for a period of up to 180 days.

Risk analysis of fluctuating hypercalcemia after leukapheresis in cellular therapy

Optimized management of citrate-induced hypocalcemia is required to provide safe leukapheresis. We prospectively analyzed subjects who underwent leukapheresis for cytotherapy, and evaluated serum ionized (iCa) concentrations before, at the end of, and 1 h after leukapheresis. During leukapheresis, calcium gluconate solution was continuously supplemented intravenously with hourly measurement of iCa. 76 patients including 49 lymphapheresis for chimeric antigen receptor T-cell therapy and 27 stem cell collections were enrolled. Median processing blood volume was 10 L (range, 6–15 L). Fluctuating hypercalcemia, in which the iCa concentration rose above its upper limit 1 h after leukapheresis, was observed in 58 subjects (76.3%). Multivariate analysis revealed that higher ratios of processing blood volume to body weight, more rapid calcium supplementation, and lower iCa concentration at the end of leukapheresis significantly increased elevation of serum iCa concentration by 1 h after leukapheresis. Based on multivariate analyses, we developed a formula and a diagram that accurately estimates serum iCa concentration 1 h post-leukapheresis. This suggests optimal targets for iCa concentration and calcium supplementation rates. In cases with high ratios of processing blood volume to body weight, slowing the rate of blood processing, rather than increasing calcium supplementation should safely alleviate hypocalcemia during leukapheresis without inducing hypercalcemia thereafter.

Effects of calcium supplementation to resuscitation fluids in endurance horses: A randomized, blinded, clinical trial.

The addition of calcium to resuscitation fluids is a common practice in horses, but studies evaluating the effects of calcium supplementation are limited. In healthy horses, decreases in heart rate and changes in serum electrolyte concentrations have been reported. Calcium gluconate administration at a rate of 0.4 mg/kg/min to eliminated endurance horses with metabolic problems will affect heart rate, gastrointestinal sounds, and serum electrolyte concentrations. Endurance horses eliminated from the Tevis Cup 100-mile (160 km) endurance ride for metabolic problems and requiring IV fluid therapy were eligible. Sixteen horses were randomly assigned to receive 0.4 mg/kg/min of calcium (23% calcium gluconate solution) over 1 hour diluted in 10 L of a non-calcium containing isotonic crystalloid (CAL group) or 10 L of a non-calcium containing isotonic crystalloid (CON group). Staff members administering the fluids were blinded to treatment group. Blood samples were collected and physical examinations performed before and after treatment. Heart rates were recorded every 15 min during fluid administration. Data were compared using 2-way analysis of variance (ANOVA) with repeated measures for continuous variables and Fisher's exact test for categorical variables. Calcium was associated with lower heart rates 45 min after starting the infusion (P = .002). Gastrointestinal sounds were less likely to improve in the calcium group compared with the control group (P = .005). An increase in plasma phosphorus concentration (P = .03) was associated with calcium administration. Intravenous calcium supplementation to endurance horses eliminated from competition after development of metabolic problems may decrease heart rate but impairs improvement in gastrointestinal sounds.

ВЛИЯНИЕ ФИЗИКО-ФАРМАКОЛОГИЧЕСКИХ ВОЗДЕЙСТВИЙ НА СОДЕРЖАНИЕ КАЛЬЦИЯ В СЫВОРОТКЕ КРОВИ ЭКСПЕРИМЕНТАЛЬНЫХ ЖИВОТНЫХ

The use of intraosseous dental implants allows solving many issues with partial and complete loss of teeth, restoring chewing function and improving facial aesthetics. And the rapid formation of a strong connection between the implant and the bone is the key to a successful result of the dental surgery. In this regard, it is of interest to develop a method for improving the biointegration of dental implants using magnetophoresis of medicinal substances, which significantly increases therapeutic efficacy. However, the issues of calcium content in its serum under the influence of the used therapeutic agents (surgical, physiotherapeutic, pharmacological) have not been sufficiently studied. Therefore, the purpose of this study was to determine the calcium content in the blood serum of experimental animals after the application of magnetophoresis solutions of 10% calcium gluconate and 5% retabolil. 16 rabbits of the "chinchilla" breed served as objects for fulfilling the goal of our work. The study made it possible to conclude that the magnetophoresis effects of calcium gluconate and retabolil solutions did not lead to a change in blood biochemistry and contributed to a short-term increase in the content of calcium and phosphorus in the blood serum of animals.

Annular elastolytic giant cell granuloma in a patient with Ehlers–Danlos syndrome

The article presents a clinical case of annular elastolytic giant cell granuloma (AEGCG) in a young patient with a vascular type of EhlersDanlos syndrome. The first clinical manifestations of AEGCG appeared on the skin in the right subclavian area about two years ago. Subsequently, new rashes appeared on the skin of the upper and lower extremities up to four new foci per year. The patient underwent ambulatory therapy as a solution of calcium gluconate 10% 5.0 ml No 10 i/v in every other day; a solution of chloropyramine hydrochloride 1.0 ml No 10 i/m every other day; betamethasone + salicylic acid ointment applied to the affected areas of the skin 2 times a day for 2 weeks. The treatment was ineffective, the rashes did not regress. External therapy with tacrolimus was carried out next, 0.1% ointment 2 times a day in the form of applications for 24 weeks but also without effect. The patient by herself started to take a dietary supplement containing 400 mg of collagen in 1 tablet; 3 types of amino acids 20 mg; vitamins B2 1.1 mg; B6 1.5 mg; calcium pantothenate 5 mg 2 tablets a day during meals. A month after the start of the application, she noticed a slight paling of the rashes. At the moment, the patient is under follow up.

Implementation of sodium alginate-Fe3O4 to localize undiagnosed small pulmonary nodules for surgical management in a preclinical rabbit model

Many methods are used to locate preoperative small pulmonary nodules. However, deficiencies of complications and success rates exist. We introduce a novel magnetic gel for small pulmonary nodules localization in rabbit model, and furtherly evaluate its safety and feasibility. Rabbits were used as the experimental objects. A magnetic gel was used as a tracer magnet, mixed as sodium alginate-Fe3O4 magnetic fluid and calcium gluconate solution. In short-term localization, a coaxial double-cavity puncture needle was applied to inject the gel into the lung after thoracotomy, and a pursuit magnet made of Nd-Fe-B permanent magnetic materials was used to attract the gel representing location of the nodule. In long-term localization, the gel was injected under X-ray guidance. Imaging changes to the lung were observed under X-ray daily. Thoracotomy was performed to excise tissue containing the gel, and hematoxylin–eosin staining was used to observe the tissue on postoperative days 1, 3, 5, and 7. Observe tissues morphology of heart, liver, spleen, and kidney in the same way. The gel was formed after injection and drew lung tissue to form a protrusion from the lung surface under the applied magnetic field. No complication was observed. The shape and position of the gel had not changed when viewed under X-ray. Pathological analysis showed the gel had a clear boundary without diffusion of magnetic fluid. All tissues retained good histologic morphology and no magnetic fluid was observed. Our study preliminarily suggested that the technique using sodium alginate-Fe3O4 magnetic gel to locate small pulmonary nodules with guidance of X-ray, and to search for them under an applied magnetic field during the operation is safe and feasible.

Fe-Cr-Nb-B Ferrofluid for Biomedical Applications.

A ferrofluid based on Fe67.2Cr12.5Nb0.3B20 magnetic particles with a low Curie temperature was prepared. The particles, most of which had dimensions under 60 nm, were dispersed in a calcium gluconate solution, leading to a stable ferrofluid. The obtained ferrofluid had a magnetization of 0.04 to 0.17 emu/cm3, depending on the particles’ concentration, and a viscosity that increased nonlinearly with the applied magnetic field. The ferrofluid appeared to be biocompatible, as it showed low cytotoxicity, even at high concentrations and for long intervals of co-incubation with human cells, demonstrating a good potential to be used for cancer therapies through magnetic hyperthermia as well as magneto-mechanical actuation.

Calcium gluconate infusion is not as effective as dopamine agonists in preventing ovarian hyperstimulation syndrome.

The aim of the study was to compare the effectiveness of calcium gluconate and cabergoline therapy in the prevention of ovarian hyperstimulation syndrome (OHSS). Eight hundred and forty-five women who underwent GnRH antagonist protocol and at high risk for developing OHSS were divided into two groups, those given cabergoline (n=435) or calcium gluconate (n=410). In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. starting on the day of ovulation trigger and continued until the following 8 days. In calcium gluconate group, intravenous calcium gluconate was administered daily for four days starting on the day of oocyte pickup (OPU). 10 ml of 10% calcium gluconate solution was dissolved in 200 ml of physiological saline and administered by intravenous route within 40 minutes. Infusion was started within the first 30 minutes following the OPU and continued on the 1st, 2nd and 3rd days after OPU. Mild OHSS was developed in 367 (89%) patients receiving calcium gluconate infusion, while 251 patients (57%) in the cabergoline group developed mild OHSS. The frequency of mild OHSS in the calcium group was significantly higher than the cabergoline group (p<.001). Moderate OHSS was observed in 32 people (7.8%) in the calcium gluconate group, while it was observed in 184 people in the cabergoline group (42.3%). Calcium gluconate infusion significantly reduced the development of moderate OHSS compared to cabergoline therapy (p<.001). Severe OHSS developed in 11 patients (2.7%) in the calcium gluconate group, while severe OHSS did not develop in those given cabergoline (0%, p<.001). Clinical pregnancy, live birth and abortion rates were similar in the two groups. When logistic regression analysis was performed, a significant correlation was found between age, BMI, AMH, the number of antral follicle count, OHSS history, paracentesis, progesterone on the day of hCG, 2 PN zygotes, and HbA1c levels and the development of OHSS. No correlation was found between the use of metformin or cetrotide and the development of OHSS. Calcium gluconate treatment is not effective in the prevention of OHSS.

NMR study of sodium gluconate solutions

Aqueous solutions of sodium gluconate have been studied by 1D and 2D NMR spectroscopy. 1H NMR spectra of solutions demonstrate the fact that in the concentration range from 4 to 200 mmol/l the shapes of the lines corresponding to different groups of protons do not change. The 13C NMR spectrum proves that the structure of sodium gluconate molecules in aqueous solution is zigzag. Fitting of the computer-simulated 1H NMR spectra to the experimental ones made it possible to find the scalar J-coupling constants of vicinal protons and on the basis of them to determine the dihedral angles (HCC’H’) in sodium gluconate molecules. The scalar J-coupling constant of vicinal protons and the dihedral angles in sodium gluconate molecules also remain unchanged in the studied concentration range. Thus, unlike calcium gluconate solutions, the conformation of sodium gluconate molecules in aqueous solutions does not depend on concentration.

Analysis on effects of modified dosage of calcium gluconate on patients with hydrofluoric acid burns not in hands or feet

Objective: To retrospectively explore the effects of modified dosage of calcium gluconate (CG) on the patients with hydrofluoric acid burns not in hands or feet. Methods: One hundred and sixty patients with hydrofluoric acid burns not in hands or feet were hospitalized in our burn ward from January 2004 to December 2017. Based on the dosage of CG at different admission time, 76 patients hospitalized from January 2004 to December 2012 were included in traditional group, and 84 patients hospitalized from January 2013 to December 2017 were included in modified group. For patients in the two groups, subcutaneous injection of CG solution at one time was immediately conducted on admission in topical treatment. In traditional group, the injection was CG solution with mass concentration of 100 g/L. For wounds of superficial partial-thickness and above degree, CG solution was prescribed at the dosage of 50 mg/cm(2). Wounds of superficial-thickness or mass fraction of hydrofluoric acid less than 20.0% did not receive injection. In modified group, the mass concentration of CG solution for injection was diluted with normal saline to 25 g/L. For wounds of deep partial-thickness and above degree, CG solution was prescribed at the dosage of (50×mass fraction of hydrofluoric acid) mg/cm(2). For wounds of superficial partial-thickness, CG solution was prescribed at the dosage of (25×mass fraction of hydrofluoric acid) mg/cm(2). For wounds of superficial-thickness, CG solution was prescribed at the dosage of 2.5 mg/cm(2). For systemic treatment, the injection velocity of CG solution via venous access was adjusted according to the level of serum calcium namely total serum calcium of patients in traditional group. In modified group, serum ionized calcium was additionally detected through automatic blood gas analyzer by the bed to regulate the injection velocity of CG via venous access. The incidence rate of hypercalcemia and mortality of patients after treatment in the two groups, and the situation about treatment of survivors in the two groups were analyzed. Data were processed with chi-square test, Fisher's exact probability test, t test, and Mann-Whitney U test. Results: (1) After treatment, 9 patients (11.8%) had hypercalcemia, while the other 67 patients (88.2%) did not have hypercalcemia in traditional group. Two patients (2.4%) had hypercalcemia, while the other 82 patients (97.6%) did not have hypercalcemia in modified group. The incidence rate of hypercalcemia of patients in traditional group was significantly higher than that in modified group (χ(2)=5.579, P=0.02). (2) There were two deaths (2.6%) and 74 survivors (97.4%) in traditional group, while there were two deaths (2.4%) and 82 survivors (97.6%) in modified group. The mortalities of patients in the two groups were close (P>0.05). (3) The ratios of eschar excision and skin grafting and hyperplastic scar formation, wound healing time, and ratio of esophageal scar stenosis of survivors in the two groups were close (χ(2)=0.002, 0.054, Z=0.66, P>0.05). Conclusions: Hydrofluoric acid is highly dangerous. The early management of patients with hydrofluoric acid burns emphasizing specialized dosage of CG for treatment can be helpful to reduce incidence of complications and improve the safety of treatment.

Effect of calcium gluconate, calcium lactate, and urea on the kinetics of self-healing in mortars

Bacteria-based healing of cracks remaining in self-healed concrete is under development to improve durability by allowing the healing of large cracks. The objective of this research was to assess the effect of several chemical compounds (called precursors) in particular calcium gluconate, calcium lactate and urea, that could first, enhance the intensity of self-healing and second, serve as nutrients at later ages for either autogenous bacteria or bacteria subsequently added by spraying the concrete surface with a bacterial suspension. Selected solutions containing precursors were used to saturate single cracks of known geometry in mortar specimens. Airflow measurements were used to monitor the healing process and to compare the kinetics of the self-healing between precursor-saturated cracks and non-precursor-saturated cracks. The 24h immersion of fresh cracks in mortars in calcium lactate or calcium gluconate solutions increased the self-healing kinetics for large cracks. This could increase the availability of calcium ions and carbonate ions, which are the main reagents for the formation of healing products. The higher initial availability of these reagents is confirmed by the rapid decrease of the apparent opening during the first month. The internal crack surfaces were covered with a thick, compact layer of healing products, mainly composed of calcite and ettringite.

Experimental research on the effects of different activators on the formation of platelet-rich gel and the release of bioactive substances in human platelet-rich plasma

Objective: To explore the effects of calcium gluconate and thrombin on the formation of platelet-rich gel (PRG) and the release of bioactive substances in human platelet-rich plasma (PRP) and the clinical significance. Methods: Six healthy blood donors who met the inclusion criteria were recruited in our unit from May to August in 2016. Platelet samples of each donor were collected for preparation of PRP. (1) PRP in the volume of 10 mL was collected from each donor and divided into thrombin activation group (TA, added with 0.5 mL thrombin solution in dose of 100 U/mL) and calcium gluconate activation group (CGA, added with 0.5 mL calcium gluconate solution in dose of 100 g/L) according to the random number table, with 5 mL PRP in each group. Then the PRP of the two groups was activated in water bath at 37 ℃ for 1 h. The formation time of PRG was recorded, and the formation situation of PRG was observed within 1 hour of activation. After being activated for 1 h, one part of PRG was collected to observe the distribution of fibrous protein with HE staining, and another part of PRG was collected to observe platelet ultrastructure under transmission electron microscope (TEM). After being activated for 1 h, the supernatant was collected to determine the content of transforming growth factor β(1, )platelet-derived growth factor BB (PDGF-BB), vascular endothelial growth factor, basic fibroblast growth factor (bFGF), epidermal growth factor, and insulin-like growth factorⅠby enzyme-linked immunosorbent assay. (2) Another 10 mL PRP from each donor was collected and grouped as above, and the platelet suspension was obtained after two times of centrifugation and resuspension with phosphate buffered saline, respectively. And then they were treated with corresponding activator for 1 h as that in experiment (1). Nanoparticle tracking analyzer was used to detect the concentrations of microvesicles with different diameters and total microvesicles derived from platelet. Data were processed with t test. Results: (1) The formation time of PRG in group TA was (228±40) s, and the PRG volume reached the maximum at this moment. The PRG volume shrunk to the minimum after 30 minutes of activation. The formation time of PRG in group CGA was (690±71) s, and the PRG volume reached the maximum at this moment. After 55 minutes of activation, the PRG volume shrunk to the minimum. The formation time of PRG in group TA was obviously shorter than that in group CGA (t=15.17, P<0.01). (2) HE staining showed that after 1 hour of activation, the red-stained area of fibrous protein in PRG of group TA was large and densely distributed, while that of group CGA was small and loosely distributed. TEM revealed that after 1 hour of activation, the platelets in PRG of group TA were fragmented, while lysing platelet structure, lysing α granule structure, intact α granule structure, and intact dense body structure were observed in PRG of group CGA. (3) The content of PDGF-BB released by PRP in group TA was (7.4±0.8) ng/mL, which was obviously higher than that in group CGA [(4.9±0.5) ng/mL, t=5.41, P<0.01]. The content of bFGF released by PRP in group CGA was (960±151) pg/mL, which was significantly higher than that in group TA [(384±56) pg/mL, t=8.75, P<0.01]. The content of the other 4 growth factors released by PRP in the two groups was close (with t values from 0.11 to 1.97, P values above 0.05). (4) The concentrations of total microvesicles, microvesicles with diameter more than 100 nm, and exosomes with diameter less than or equal to 100 nm derived from platelet in group CGA were (165.8±15.1)×10(8)/mL, (142.4±12.3)×10(8)/mL, and (23.4±2.9)×10(8)/mL respectively, which were significantly higher than those in group TA [(24.7±4.6)×10(8)/mL, (22.6±4.0)×10(8)/mL, and (2.1±0.7)×10(8)/mL, with t values from 17.36 to 22.66, P values below 0.01]. Conclusions: Calcium gluconate can slowly activate PRP, resulting in slowly shrunk PRG with high content of bFGF and high concentration of microvesicles, which is suitable for repairing articular cavity and sinus tract wound. Thrombin can rapidly activate PRP, resulting in quickly shrunk PRG with high content of PDGF-BB and a certain concentration of microvesicles, which is suitable for repairing acute trauma.

Предупреждение повышенной кровопотери и коагулопатического кровотечения при абдоминальном родоразрешении

The purpose of the study - to assess the effectiveness of intraoperative application of complex drugs calcium gluconate (10 ml of 10% solution) and tranexamic acid (1.0 g) for abdominal delivery of patients with disorders in the fibrinolytic links of blood coagulation. Material and methods. We observed 160 patients, delivery by caesarean section, which carried out by one and the same surgical team. All pregnant women are at risk for the development of coagulopathic bleeding. The average age of patients was 28.3±1.7 years. Observed were divided into equal groups and the number of subgroups (40 persons in each). According to the developed method, a specified author invention priority reference from 18.07.2016, Application №2016129336(045647), one group of patients at the time of abdominal wall incision sequentially intravenously injected into a peripheral vein with 10 ml of 10% solution of calcium gluconate and tranexamic acid. The patients in the other groups these drugs are either not used or used individually. The results. A decrease in the 2.5-1.5 times the total blood loss in patients who have a caesarean section at the complex were used calcium preparations and tranexamic acid, compared with women who did not receive these drugs, or treated them separately. In addition to clinical observation and gravimetric method of counting blood loss, a positive impact has a tranexam on perioperative volume so reduction and it has been proven by laboratory tests. Conclusion. To prevent the coagulopathic bleeding and reduce the total perioperative blood loss, highly effective and safe is the combined use of drugs calcium gluconate and tranexamic acid for the above scheme with operative delivery of patients with disorders of fibrinolytic level in the blood coagulation system.

Aluminum and Phthalates in Calcium Gluconate: Contribution From Glass and Plastic Packaging.

Aluminum contamination of parenteral nutrition solutions has been documented for 3 decades. It can result in elevated blood, bone, and whole body aluminum levels associated with neurotoxicity, reduced bone mass and mineral content, and perhaps hepatotoxicity. The primary aluminum source among parenteral nutrition components is glass-packaged calcium gluconate, in which aluminum concentration in the past 3 decades has averaged approximately 4000 μg/L, compared with <200 μg/L in plastic container-packaged calcium gluconate. A concern about plastic packaging is leaching of plasticizers, including phthalates, which have the potential to cause endocrine (male reproductive system) disruption and neurotoxicity. Aluminum was quantified in samples collected periodically for more than 2 years from 3 calcium gluconate sources used to prepare parenteral nutrition solutions; 2 packaged in glass (from France and the United States) and 1 in plastic (from Germany); in a recently released plastic-packaged solution (from the United States); and in the 2 glass containers. Phthalate concentration was determined in selected samples of each product and leachate of the plastic containers. The initial aluminum concentration was approximately 5000 μg/L in the 2 glass-packaged products and approximately 20 μg/L in the plastic-packaged product, and increased approximately 30%, 50%, and 100% in 2 years, respectively. The aluminum concentration in a recently released Calcium Gluconate Injection USP was approximately 320 μg/L. Phthalates were not detected in any calcium gluconate solutions or leachates. Plastic packaging greatly reduces the contribution of aluminum to parenteral nutrition solutions from calcium gluconate compared with the glass-packaged product.

Enhancement of Ocular In Situ Gelling Properties of Low Acyl Gellan Gum by Use of Ion Exchange.

The purpose of this study was to determine if the addition of calcium gluconate to gellan solution results in a stronger gel structure on initial exposure to tear fluid due to the displacement of calcium from the gluconate ion by tear monovalent cations (Na+, K+). Test solutions of gellan and gellan-calcium gluconate were mixed thoroughly with simulated tear fluid (STF) at a 5:1 ratio. The resulting gel was measured for viscosity at 32°C-36°C. The addition of optimized amounts of calcium gluconate to gellan formulations resulted in gellan-calcium gluconate-STF gels of higher strength (statistically significant) than when gellan alone was mixed with STF. Gellan experimental preparations demonstrated thixotropic behavior both before and after addition of STF. It appears possible to enhance the initial in situ gel-forming properties of gellan by adding a divalent cation bound to an ion exchange molecule or resin. Optimal amounts of polyvinylpyrrolidone (PVP) appear to be effective in slowing timolol release when added to gellan and calcium gluconate solutions.

Chemical burn caused by high-concentration hydrofluoric acid: a case that followed a lethal course

Chemical burns from Hydrofluoric Acid (HFA) are poorly recognized, even though we sometimes encounter patients affected by these burns. HFA can cause lethal arrhythmia due to hypocalcemia and hypomagnesemia, particularly in cases of high-concentration HFA exposure. A 57-year-old man received lower body injuries from splashes of 50% HFA solution by an accident. He was transferred to our hospital by a helicopter emergency medical service (Doctor Heli). 10 mL of calcium gluconate solution (8.5% calcium gluconate) had been already administered before arrival to the emergency room. However, hypocalcemia was prolonged, fatal arrhythmia appeared, and we started the continuous administration of calcium gluconate. We amputated his leg in order to prevent systemic spreading of HFA. Further, we administered a massive transfusion of saline with catecholamine for the treatment of shock. However, the patient died after 7 hrs. In many reported cases of exposure to high-concentration HFA, death from fatal arrhythmia occurred within 1hr. Our patient was able to survive for 7 hrs, perhaps because of the early and intensive administration of calcium formulation and intensive care. This case serves as a warning to persons handling HFA, emergency physicians and dermatologists, who should recognize the corrosive nature and the potential risks of HFA to avoid tragic outcomes.

Effectiveness of intra-articular injections of sodium bicarbonate and calcium gluconate in the treatment of osteoarthritis of the knee: a randomized double-blind clinical trial.

BackgroundA novel therapeutic management of osteoarthritis (OA) of the knee was assessed. The study aimed to evaluate the effect of monthly sodium bicarbonate with a single (SBCG1) or double dose (SBCG2) of calcium gluconate injections on OA of the knee; as well as the efficacy and safety of both SBCG interventions in the long term.MethodsA double-blind parallel-group clinical trial with 74 knee OA patients was performed during 12 months, both SBCG interventions were followed-up for another 6mo after intervention. The outcome variables were the Western Ontario-McMaster University Osteoarthritis Index (WOMAC), the Lequesne’s functional index and joint-space width changes from serial radiographs.ResultsAfter 12 months, group SBCG1 decreased −14.8 (95% CI:-14.2, −17.0) and group SBCG2 decreased −14.6 (−16.9, −12.4) in the global WOMAC score, the mean changes represent 80% and 82% lessened pain, respectively. In the Lequesne Functional Index scale, SBCG1 decreased −11.9 (−10.4, −14.2) and SBCG2 decreased -11.9 (−13.8, −10.0), representing 66 and 69% of improvement. Both mean scores were maintained after intervention discontinued. SBCG2 improved the knees’ joint space width more than SBCG1 at 3 and 18 months. Both SBCG interventions were well tolerated after 12 months of treatmentConclusionA solution of sodium bicarbonate and calcium gluconate is effective on reducing the symptoms associated with OA. Its beneficial effect is maintained for one year of continuous monthly administration and at least for 6 months after the administration is discontinued. When the dose of calcium gluconate is increased, it prevents further narrowing of joint-space.Trial registrationClinicaltrials.gov NCT00977444 September 11, 2009.

Preparation and application of an innovative thrombocyte/leukocyte-enriched plasma to promote tissue repair in chelonians.

Platelet concentrates are widely used in mammalian regenerative medicine to improve tissue healing. Chelonians (Testudines) would benefit from the application of thrombocyte preparations to regenerate damaged tissues, since traumatic injuries are leading causes of morbidity and mortality for both wild-living and domesticated animals. The aim of this study was to establish a protocol that optimized the recovery of the thrombocytes from blood samples and to show the efficacy of thrombocyte-enriched plasma in chelonians. Peripheral blood samples were obtained from Testudo spp. (n = 12) and Trachemys scripta elegans (n = 10). Blood cells were fractionated by sodium diatrizoate-sodium polysucrose density gradient using a two-step centrifugation protocol. Thrombocytes and leukocytes were isolated and resuspended to obtain thrombocyte-leucocyte rich plasma (TLRP). The mean recovery of leukocytes and thrombocytes was 48.9% (±4.0 SEM, n = 22) of the whole blood cell content. No statistically significant difference was observed between blood samples collected from different turtle species. The ability of TLRP to form a gel was evaluated by adding variable concentrations of calcium gluconate at room temperature and at 37°C. A reliable and consistent clotting of the TLRP was obtained in glass tubes and dishes by adding 5-20% v/v of a 100 mg/ml solution of calcium gluconate. Furthermore, in order to test the clinical efficacy of TLRP, a preliminary evaluation was performed on four turtles (Testudo spp.) with traumatic injuries. In all the four animals, a successful clinical outcome was observed. The results demonstrated that a thrombocyte-enriched plasma, comparable to mammalian platelet rich plasma, can be prepared from chelonian blood samples. Furthermore, although the low number of cases presented does not allow definitive conclusions from a clinical point of view, their outcome suggests that TLRP application could be further investigated to improve the healing process of both soft and hard tissue injuries in chelonians.

A Filtration System That Greatly Reduces Aluminum in Calcium Gluconate Injection, USP Used to Prepare Parenteral Nutrition Solutions.

The study objective was to reduce aluminum (Al) in Calcium Gluconate Injection, US Pharmacopeia (USP) used in the preparation of parenteral nutrition (PN) solutions. A flow-through filter containing an immobilized chelator that complexes Al from Calcium Gluconate Injection, USP as it flows through the filter was designed, refined by design modifications, and extensively tested. When a small-volume parenteral vial containing 100 mL of Calcium Gluconate Injection, USP is connected on the inlet side of the filter, and the outlet side is connected to an evacuated receiving vial, the filtered solution is drawn into the receiving vial. This constitutes a complete system to remove Al from Calcium Gluconate Injection, USP. The extent of Al removal is flow rate dependent. At a flow rate of 1 mL/min approximately 85% of the Al was removed from calcium gluconate solution. PN solutions have been reported to deliver 15 to 23 mcg/kg/day Al to neonates. Given that Calcium Gluconate Injection, USP provides 85% of the Al in neonatal PN solutions, removal of 85% of the Al from this source was calculated to reduce Al delivered to most neonates to <5 mcg/kg/day. A point-of-use, self-contained, single-use, disposable, Al-complexing filter has been created. It was calculated to reduce Al delivered in PN solutions by 72%, resulting in daily Al delivery below the level that results in Al accumulation associated with central nervous system and bone toxicity to all but the smallest (<1 kg) infants.