Calcium Phosphorus Research Articles

Serum irisin levels and osteoporosis in patients with advanced chronic kidney disease and renal transplant recipients

AimTo elucidate the association of serum irisin levels with bone mineral density (BMD) and calcium–phosphorus metabolism parameters in chronic kidney disease (CKD) patients and renal transplant recipients (RTRs).MethodsThis is a cross-sectional study involving CKD patients and RTRs. Healthy volunteers served as controls. Age, gender, and dialysis vintage were recorded. Serum irisin, creatinine, glucose, calcium, albumin, 25(OH) vitamin D, ferritin, C-reactive protein, A1C, and lipid profile were studied in all participants. Estimated glomerular filtration rate (eGFR), corrected calcium, and body mass index (BMI) were calculated.ResultsOverall, 49 patients (23 hemodialysis, 26 RTRs) and 25 control subjects were included. In hemodialysis (HD) group, 8 patients (34.8%) had osteoporosis, and 12 patients (52.2%) had osteopenia. In RTR group, 3 patients (11.5%) had osteoporosis, while 15 patients (57.7%) had osteopenia. Among controls, one had osteoporosis, and 7 had osteopenia. There was no significant difference between HD and RTRs; however, osteoporosis rate was significantly lower in control subjects. BMD measurements (femur and lumbar T- and Z-scores) were comparable between HD and RTR groups. Control group DEXA values were similar to RTRs; however, they were significantly higher compared to HD group. 25(OH) vitamin D levels were comparable between the HD and RTR groups, and these were significantly lower compared to values of the control group. Mean serum irisin level was 426.6 ± 191.2 pg/mL in hemodialysis group, 342.6 ± 174.8 in the RTR group, and 208.0 ± 186.1 in controls. Serum irisin levels were similar in RTR and HD groups, but their values were significantly higher compared to controls. When we compared serum irisin levels between patients with and without osteoporosis in the whole cohort and hemodialysis and RTR groups, there was no difference. Serum irisin was positively correlated with lumbar T-score both in hemodialysis and RTR groups.ConclusionOur study is the first in the literature revealing the positive correlation of serum irisin level with femur T-score in RTRs. Serum irisin level was also positively correlated with femur T-scores in hemodialysis patients.

Biochemical parameters of blood in cats with cardiogenic arterial thromboembolism and acute heart failure

Investigating the impact of vascular blockage on blood biochemical parameters, particularly in the context of acute heart failure, is crucial for understanding the underlying mechanisms of arterial thromboembolism in animals. The purpose of the study is to investigate the effect of vascular occlusion on the biochemical parameters of blood in cats with cardiogenic arterial thromboembolism. The study involved 12 cats and formed two groups: the first – animals with acute heart failure and the second – animals with arterial thromboembolism. Anamnesis data were collected for experimental animals, clinical examination, echocardiography, and biochemical examination of blood samples were performed. The activity of alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transpeptidase, the concentration of glucose, creatinine, urea, potassium, calcium, total and inorganic phosphorus were determined spectrophotometrically in blood serum. It was found that in cats with acute heart failure, the average value of serum aspartate aminotransferase activity increased by 2.8 times, and the creatinine concentration by 1.9 times compared to the upper limit of reference values. This indicates functional changes in the myocardium and kidneys in this pathology. In cats affected by arterial thromboembolism, the blood serum shows a significant elevation in various biochemical parameters compared to the upper limit of the corresponding reference intervals. Specifically, there is a 4.4-fold increase in alanine aminotransferase activity, a 4.3-fold increase in aspartate aminotransferase activity, a 1.4- fold increase in glucose concentration, a 1.8-fold increase in creatinine levels, a 2.0-fold increase in urea levels, and a 1.3-fold increase in inorganic phosphorus levels. The changes in biochemical parameters for feline thromboembolism may be a consequence of functional renal failure, ischemia, and muscle necrosis. Moreover, it was established that in most cats with acute heart failure, the urinary system is primarily affected, and with arterial thromboembolism, changes in muscle tissue also occur. The results obtained are of practical value for veterinary doctors when choosing a therapeutic strategy and prescribing additional diagnostic examinations

Evaluation of Phosphorus Storage and Performance of Broilers Using Phytase Synthetic Enzyme.

Phytic acid is a stored form of phosphorus in cereals, 65 to 70% of phosphorus in plant sources is phytate, and broilers are only able to use part of the phosphorus in plant sources. To meet the needs of chickens, it is necessary to use other artificial resources, which not only impose part of the cost of the breeding period because of its presence in the manure but is one of the factors polluting the environment. This study aimed to use different levels of phytase enzyme to reduce dietary phosphorus levels. 600 Ross 308 broilers were used in this experiment with five treatments and six replications, and in each replication, 20 chickens were used in a completely randomized design (CRD). Experimental treatments include 1) basal diet (control) 2) basal diet with 15% less phosphorus 3) basal diet with 15% less phosphorus + 1250 (FTU) phytase enzyme 4) basal diet with 15% less phosphorus + 2500 (FTU) phytase enzyme 5) basal diet with 15% less phosphorus + 5000 (FTU) phytase enzyme. The evaluated traits included weekly feed intake, weekly weight gain, feed conversion ratio, carcass characteristics, ash, calcium, and bone phosphorus. The use of phytase enzyme in different diets had no significant effect on food intake, weight gain, and feed conversion ratio (P>0.05). However, the use of phytase in different diets significantly affected the percentage of Gizzard, Heart, Liver, Proventriculus, and Spleen (P<0.05). The most changes were the increase in the ratio of feed intake and weight gain in the fourth week compared to the third week so that the changes in the ratio of feed intake ranged from 1.85 to 1.91, and this ratio for weight gain also ranged from 3.12 to 3.86 was recorded, and the lowest feed conversion ratio was obtained at the same age. The percentage of raw ash in broiler chickens was significantly increased by adding dietary phytase. The lowest amount of ash, calcium, and phosphorus belonged to the second group (diets with low phosphorus and no enzyme). The difference between the other groups and the control was not significant. Feed intake, weight gain, and feed conversion ratio with the addition of phytase enzyme were not affected by phosphorus reduction and had no significant effect on carcass characteristics. Environmental pollution can be prevented by reducing the level of dietary phosphorus and reducing excreted phosphorus.

Phosphorus Additives and Their Impact on Phosphorus Content in Foods—An Analysis of the USDAs Branded Foods Product Database

The frequency of phosphate additives reported in the United States Department of Agriculture Branded Foods Product Database and how these additives impact phosphate content is unknown. All products included in the Branded Foods Product Database reporting phosphorus content were reviewed for presence of phosphate salts and/or lecithin additives. Phosphorus content information was available for 3,466 (1.45%) food items, of these 1791 (51.6%) contained additives. Median phosphorus content was lowest in products with lecithin only compared to products without phosphorus additives (86 [54-200] vs. 145 [77-351] mg per 100 g, P<.01), which was not different from products with phosphate salts (176 [101-276] mg per 100 g, P=.22) or products with both phosphate salts and lecithin (161 [99-285] mg per 100 g, P=1.00). The impact of a phosphorus salt on phosphorus content (mg per 100) was explored among ultra-processed products grouped by similar phosphorus contents. The phosphorus content of in in nondairy alternatives, dairy, plant proteins, and grains were significantly higher when the product contained a phosphate salt compared to products without a phosphate salt. For all products phosphorus and potassium content were correlated, but the relationship was stronger for when a potassium phosphate additive was present compared to absent (rho=0.81 vs. 0.53, P<.05). Similar patterns were seen for sodium, calcium, and iron with stronger correlations with phosphate content for products with additives than those without (calcium phosphate: rho=0.47 vs. 0.32; iron phosphate: rho=0.47 vs. 0.33; sodium phosphate: rho=0.45 vs. 0.07. All P<.05). The relationship between phosphate and sodium for products without phosphate additives was weak. Lecithin may not be associated with increased phosphorus content. Calcium, potassium, sodium, and iron phosphorus salts appear to be associated with increases in the composite mineral and phosphorus content, with the strongest correlation between potassium and phosphorus content.

Could primary hyperparathyroidism develop in cases with neurofibromatosis type-1-associated pheochromocytoma: Two cases with pheochromocytoma gene panel analysis

Abstract Introduction Neurofibromatosis type-1 (NF-1) is an autosomal dominant genetic disorder. It is associated with the development of café-au-lait macules, axillary and/or inguinal frecklings, Lisch nodules, hypertension, osteoporosis, skeletal abnormalities, as well as benign and malignant tumors, such as optic gliomas, peripheral nerve sheet tumors, and rarely, pheochromocytomas. However, primary hyperparathyroidism is rarely documented in patients with bilateral pheochromocytomas associated with NF-1 and is typically linked to MEN-2 A syndrome. Here we present two cases of NF-1-associated bilateral pheochromocytomas who developed primary hyperparathyroidism during follow-up. Clinical case In 2010, diagnostic ultrasonography performed for abdominal pain in a 60-year-old female patient revealed an adrenal mass. Multiple neurofibromas, axillary freckling, café-au-lait macules, and lisch nodules were found on physical examination (Figure 1A, B, C, and D). A diagnosis of pheochromocytoma was confirmed by high urine metanephrines and a hyperintense, 35 x40 mm mass on T2 weighted MRI sequences. The patient underwent right adrenalectomy. One year later, a diagnosis of primary hyperparathyroidism was made based on the high serum levels of calcium and intact PTH, and low serum phosphorus levels (Table-1). Radiotracer uptake was seen on a parathyroid MIBI scan in the thyroid's right inferior area. During follow-up, a 50×51 mm mass, hyperintense on T2 weighted MRI sequences was discovered on the left adrenal gland (figure 1-E). A diagnosis of pheochromocytoma was confirmed by detecting high plasma metanephrine and normetanephrine levels. The patient underwent left adrenalectomy 5 years following the initial diagnosis. Clinical case A 64-year-old female patient was admitted due to recently developed hypercalcemia. She had previously undergone two successive adrenalectomies, 4 years apart in 1999 and 2003, and was confirmed to have bilateral pheochromocytomas by histopathological analysis. Multiple neurofibromas, axillary freckling, café-au-lait macules, and Lisch nodules were found on physical examination. A diagnosis of primary hyperparathyroidism was made by detecting high serum calcium, intact parathormone, and low serum phosphorus levels. The patient underwent a right parathyroidectomy in 2012. In both cases, a panel analysis of pheochromocytoma gene mutations was carried out. In cases 1 and 2, a heterozygous nonsense mutation (17q11.2, C.2023G&amp;gt;T (P.G675*) and a non-frameshift deletion (17q11.2 c.5036) in the NF-1 gene were respectively found. Both instances tested negative for genetic alterations for RET, FH, MAX, SDHA, SDHB, SDHC, SDHD, SDHAF2, TMEM-127, and VHL. Conclusion The development of primary hyperparathyroidism in these two cases of pheochromocytomas associated with genetically confirmed NF-1 raises the possibility that primary hyperparathyroidism may develop in patients with NF-1-associated pheochromocytoma.

The effect of conventional and self-ligating brackets on salivary biochemical indicators

The use of orthodontic fixed systems is often accompanied by physical discomfort, pain of varying intensity, psycho-emotional stress, and sleep disturbances. Treatment also affects salivary cortisol, alpha-amylase, magnesium, calcium, and inorganic phosphorus concentrations, although data are conflicting and scarce. The aim of our study was to compare of electrolytes and alkaline phosphatase concentrations in oral fluid after 2 months of treatment (conventional and self-ligating braces respectively). In total40 patients (20 in each group) were studied. According to the obtained results, the concentrations of calcium and alkaline phosphatase differ significantly between standard and self-ligating treatments, while magnesium and phosphorus ions do not change. Based on the results of the study, calcium and alkaline phosphatase indicators can be used to prevent expected side effects of treatment.

Growth studies in commercial broiler birds offered citric acid in formulated feed with low mineral density.

Study of 35days was conducted to evaluate citric acid (CA) as an additive in poultry broiler feed with lower mineral content of calcium (Ca) and total phosphorus (TP) in commercial broiler poultry birds for its effect on growth, nutrient utilization, carcass characteristics, and economics. Vancobb-400 strain day old broiler chicks were divided into four main treatment groups T0, T1, T2, and T3. Treatment groups were further divided into eight replicates with ten chicks in each. T0 served as control, given standard corn-soy flakes-based ration (Pre-starter %: Crude protein (CP)-23, Ca-1.00, TP-0.70; Starter %: CP-22, Ca-1.10, TP-0.72, and Finisher %: CP-20, Ca-0.99, TP-0.70). Treatment T1 served as positive control with added 0.5% CA (Pre-starter %: CP-23, Ca-1.00, TP-0.70; Starter %: CP-22, Ca-1.10, TP-0.72 and Finisher %: CP-20, Ca-0.99, TP-0.70). Treatment T2 was given feed containing 0.5% CA with low Ca and TP content (Pre-starter %: CP-23, Ca-0.90, TP-0.66; Starter %: CP-22, Ca-0.99, TP-0.71 and Finisher %: CP-20, Ca-0.90, TP-0.69), whereas treatment T3 was given feed containing 0.5% CA with moderately low Ca and TP content (Pre-starter %: CP-23, Ca-0.80, TP-0.65; Starter %: CP-22, Ca-0.88, TP-0.70 and Finisher %: CP-20, Ca-0.79, TP-0.68). Birds offered moderately low Ca and TP with 0.5% CA addition, exhibited higher growth rate (P < 0.05), better nutrient utilization with positive influence on dressing percentage and forequarters weight. Economics of broiler feeding revealed that 0.5% CA supplementation fetched highest gross return above feed cost in broiler birds offered feed with moderately low Ca and TP content whereas lowest profit was recorded in feed with low content of Ca and TP. In conclusion, supplementation of 0.5% CA in feed with low and moderately low Ca and TP content positively influenced overall growth, and carcass characteristics. Economics of broiler feeding with moderately low Ca and TP content revealed highest profit with CA (0.5%) supplementation.

Biologic Bone Behavior During the Osseointegration Process: Histologic, Histomorphometric, and SEM-EDX Evaluations.

This study evaluated bone behavior during dynamic osseointegration. A total of 12 implants were placed in sheep tibia and analyzed at 15, 30, 60, and 90 days. Quantitative and qualitative bone behaviors were evaluated with histologic, histomorphometric, Alizarin Red S, and SEM-EDX (scanning electron microscopy with energy-dispersive x-ray spectroscopy) analysis. Twenty microanalyses were performed in chambers 1, 3, and 5 (a chamber is the distinctive space/bone volume between two coils of the implant screw) in distinctive zones: the titanium-bone interface (zone A), the middle chamber-bone front (zone B), the bone-surgical threading interface (zone C), and native bone (zone D; used as a control). The dynamic osseointegration index (DOI) and bone quality index (BQI) with calcium/phosphorus (Ca/P) content were detected to evaluate the osseointegration quality, bone-to-implant contact (BIC), and bone density around implants. At 15 days, initial bone formation with osteoid matrix deposition and different color intensities were observed (means: BIC = 23.3% ± 3.9%; DOI = 1.55). SEM-EDX analysis showed low mineralized bone/bone marrow with a very low Ca/P mean value. At 30 days, high new bone deposition with higher color intensity in the crestal portion was recorded (BIC = 77.3% ± 0.4%; DOI = 2.58). At 90 days, tight BIC to the middle and apical implant portions were detected, as well as several osteon structures in the crestal portion (BIC = 86.4% ± 0.6%; DOI = 0.96). During all observed time periods, the BQI showed 25% more Ca/P in zone A. Greater maturation degree and lower BQI were seen at zone A compared to the other zones. After 15 and 30 days, zones B and C (except for P in zone B) showed BQIs slightly over 50% and around 75%, respectively, confirming a progressively higher degree of bone maturation that proceeds with the osseointegration process. After 90 days, the BQI values of zones B and C (greater than 70% in zone B and around 90% in zone C) confirmed the bone mineralization and maturation process and an acceleration of implant osseointegration, while a lower BQI value (25%) was recorded in zone A. This study shows osseointegration as a variable dynamic process with a higher bone deposition in contact with the implant surface during the early phase, while in the active and later osseointegration times, the bone quality maturation showed higher values only "at distance" (growth of native bone to the implant surface, observed later in the osseointegration process). After 3 months (before loading), the BQI evaluation was lower (25%) in zone A, confirming that the healing and maturation process of the bone cannot be considered complete.

A Novel Bacterial 6-Phytase Improves Productive Performance, Precaecal Digestibility of Phosphorus, and Bone Mineralization in Laying Hens Fed a Corn-Soybean Meal Diet Low in Calcium and Available Phosphorus.

Exogenous phytases are commonly added to low-phosphorus and low-calcium diets to improve P availability and reduce P excretion by poultry. This study investigated the effect of supplementation with a novel bacterial 6-phytase on egg production, egg quality, bone mineralization, and precaecal digestibility of P in laying hens fed corn-soybean meal-based diets. A total of 576 Hy-Line brown laying hens were used in a completely randomized block design at 25-45 weeks of age (woa). The three treatments included a positive control (PC) adequate-nutrient diet with 2840 kcal metabolizable energy/kg, 0.77% digestible lysine, 3.5% Ca, and 0.30% available P (avP); a negative control (NC) diet with 0.16% points less Ca and avP; and an NC diet supplemented with a novel bacterial 6-phytase at 300 phytase units/kg diet. Hen performance and the percentage of damaged eggs were measured every 4 weeks. Body weight, precaecal digestibility of P, and bone parameters at 45 woa were also measured. The reduction in avP and Ca in the NC diet did not compromise performance or egg quality. However, it decreased (P < 0.001) body weight, tibial dry matter, tibial ash and P content, and precaecal digestibility of P. Importantly, all these parameters were significantly improved (P < 0.001) and essentially restored to the levels measured in PC diet-fed hens upon supplementation with phytase. In summary, the present study demonstrates that the new bacterial 6-phytase could effectively counteract the negative effects of P and Ca deficiencies on body weight, bone mineralization, and P availability, thereby supporting high productivity without compromising the welfare of laying hens.

Fitase em dietas com diferentes concentrações de fitato para frangos de corte

ABSTRACT: This study evaluated the effect of including different doses of phytase in broiler diets with different levels of phytate and reduced levels of calcium (Ca) and available phosphorus (aP), on broilers performance, digestibility (CAID), and bone characteristics. One thousand four hundred and four Cobb®500 broilers were used, distributed in a complete randomized design, and a 2x3 factorial arrangement, with two phytate levels (4.25 kg/ton - MP and 6.0 kg/ton - HP) and three phytase levels (0, 750, and 1500 FTU/kg) totalizing six treatments with nine replicates each. The animals that received phytase in their diet showed higher average feed intake and weight gain, and higher bone weight, % mineral residue, % Ca, and % P, when compared to the treatment without phytase (P &lt; 0.01). Animals that received a diet containing HP with the inclusion of 1500FTU/kg phytase had the best CAID of nutrients (P &lt; 0.0001). Regarding phytate, animals that received the MP diet showed a higher CAID of dry matter, and higher %P in the tibia when compared to animals that received the HP diet. The addition of phytase to diets with reduced Ca and aP levels can improve the CAIDs and bone characteristics in the presence of high phytate levels. However, reducing Ca and aP levels in the diet without adding phytase impairs the performance of broilers and has no effect on their carcass and cuts yield.

Expression of sclerostin and bone morphogenetic protein-7 (BMP-7) in serum of patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and their correlation with calcium and phosphorus metabolism

Calcium and phosphorus metabolism involves in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD). Sclerostin and bone morphogenetic protein-7 (BMP-7) are closely related to bone formation. This study aims to assess sclerostin and BMP-7’s role in renal function, blood calcium and phosphorus in CKD-MBD. 86 CKD-MBD patients were collected as the case group and 86 healthy subjects were selected as control group. ELISA was used to detect Sclerostin and BMP-7 serum level. The automatic biochemical analyzer was used to detect liver and kidney function. Blood calcium and phosphorus level, and iPHT level was detected by immunoradiation. No differences were found regarding age, gender, and BMI between case group and control group (P > 0.05). Compared to controls, CKD-MBD patients had significantly reduced blood calcium and eGFR level, and increased Scr, BUN, blood phosphorus and iPTH level (P < 0.05) with increased Sclerostin (t = 33.86, P < 0.001), and reduced BMP-7 level (t = 329.38, P < 0.001). Scr, BUN, blood phosphorus levels and iPTH were correlated with Sclerostin positively (P < 0.05) and BMP-7 negatively (P < 0.05). eGFR and blood calcium were correlated with Sclerostin negatively (P < 0.05) and BMP-7 positively (P < 0.05). Scr, eGFR, blood calcium levels, blood phosphorus levels, and iPTH are independent risk factors for serum Sclerostin and BMP-7 level. Sclerostin and BMP-7 changes may be important factors affecting the occurrence of CKD-MBD. Renal function, blood calcium and blood phosphorus are independent risk factors for serum Sclerostin and BMP-7 level.

Correlation of Serum FGF23 and Chronic Kidney Disease-Mineral and Bone Abnormality Markers With Cardiac Structure Changes in Maintenance Hemodialysis Patients.

CKD-MBD is a mineral and bone metabolism syndrome caused by chronic kidney disease. FGF23 is an important factor regulating phosphorus and is the main influencer in the CKD-MBD process. In this study, we observed the correlation among serum FGF23 and calcium, phosphorus and parathyroid hormone, and the correlation between FGF23 levels and cardiac structural changes in MHD patients. We examined serum FGF23 concentrations in 107 cases of MHD patients using the ELISA method, recorded demographic information and biochemical data, and analyzed the correlation between serum FGF23 levels and blood calcium and blood phosphorus and PTH levels. All patients were evaluated by cardiac color ultrasound, and we finally analyzed the association between the FGF23 level and cardiac structural changes. In 107 cases of MHD patients, serum FGF23 levels were linearly associated with serum calcium (r = 0.27 P < 0.01) and parathyroid hormone levels (r = 0.25, P < 0.05). FGF 23 was negatively correlated with age (r = -0.44, P < 0.01).Serum FGF23 levels were correlated with right atrial hypertrophy in HD patients (P < 0.05). No correlation was found among FGF23, left ventricular hypertrophy/enlargement, and valve calcification stenosis (P > 0.05). Serum FGF23 showed a positive correlation among blood calcium levels and PTH levels in hemodialysis patients, and FGF23 levels can affect the incidence of right atrial hypertrophy in MHD patients.

PS-C02-7: ANALYSIS OF ELECTROLYTE CHARACTERISTICS IN PATIENTS WITH PRIMARY ALDOSTERONISM COMPLICATED WITH ARRHYTHMIA

Background: primary aldosteronism is important for electrolyte balance in addition to its direct cardiovascular effects. High aldosterone can aggravate electrolyte disorder, resulting in low potassium, low calcium, high sodium, low phosphorus and so on. Electrolyte balance is the basis of maintaining normal electrophysiological activity of cells. Electrolyte disturbance can affect cardiac electrical activity, and then may induce a series of arrhythmias, increase cardiovascular burden, hospitalization rate and mortality rate. Objective: To study the electrolyte characteristics of arrhythmia in patients with primary aldosteronism. Methods: A retrospective study was performed on 287 patients diagnosed with primary aldosteronism who were admitted to the Department of Cardiology, Second Clinical Hospital of Lanzhou University from January 2018 to May 2021, and they were divided into arrhythmia group (n = 137 cases) and non-arrhythmia group (n = 150 cases) according to whether they had arrhythmia. The electrolyte characteristics of the two groups were compared. Results: There were no significant differences in age, gender, basal blood pressure, activity of sitorenin, blood sodium, blood calcium, blood magnesium and blood phosphorus between the two groups (P &gt; 0.05). Compared with the group without arrhythmia, serum potassium in the group with arrhythmia was lower(P &lt; 0.05)., the sitting plasma aldosterone and body mass index (BMI) were higher (P &lt; 0.05), and the detection rate of hypokalemia was higher in patients with arrhythmia (P &lt; 0.0)5). Speatman correlation analysis showed that there was a positive correlation between sitting aldosterone and BMI (R = 0.311, P &lt; 0.05), and a negative correlation between sitting aldosterone and potassium (R = -0.253, P &lt; 0.05). Conclusion: Hypokalemia is the characteristic of electrolytes in patients with arrhythmia. In the electrolysis disorder caused by increased aldosterone, hypokalemia is more likely to induce arrhythmia. In addition, patients with primary aldosteronism with higher BMI are more likely to develop arrhythmias, and there may be a certain correlation between BMI and blood potassium, which needs further demonstration.

Energy levels and lysine, calcium and phosphorus adjustments on broiler nutrient digestibility and performance.

Chicken broilers digestibility and performance fed with different ME levels, with and without adjustments of digestible lysine, calcium, and available phosphorus, were evaluated. For digestibility, 210 male Cobb 500 chicken broilers were used and distributed into a 3x2+1 factorial arrangement, with three ME levels (3050; 3125 and 3200 kcal/kg) with and without nutrient adjustment, plus one control treatment (2975 kcal ME/kg), totaling seven treatments including six repetitions with five birds into each repetition. For initial performance, 1120 birds were distributed randomly with eight replications within treatments and 20 birds for each replication. For final performance, 1008 chickens were distributed with eight replications and 18 birds for each replication. The DCDM and DCCP were improved (P<0.05) according to the increase of ME and the adjustment in dietary nutrients, as well as GE digestibility. The final performance showed no interaction (P>0.05) between energy and nutrient adjustment, but the increase in energy levels improved the feed conversion ratio (FCR=1.370). Increasing energy density with nutrient adjustment improves both nutrient utilization and bird performance.

The effects of electrodeposition temperature on morphology and corrosion resistance of calcium phosphorus coatings on magnesium alloy: comparative experimental and molecular dynamics simulation studies.

In this study, CaP coatings were prepared on the surface of an AZ31B magnesium alloy using electroplating in order to slow down the degradation rate of magnesium alloy in the simulated physiological environment. The effect of plating temperature on the properties of CaP coatings was investigated by combining experimental techniques with molecular dynamics (MD) simulation. The surface morphology of CaP coatings changed from dendritic lamellar to granular structure with the increase of plating temperature, but the main structure of CaP coatings prepared at all temperatures was CaHPO4·2H2O. The CaP coatings prepared at 60 °C have higher corrosion resistance compared to coatings prepared at other temperatures. The MD simulation revealed the DCPD/Mg interfacial binding mechanism, and DCPD/Mg could form a stable interfacial layer at different temperatures because the binding energy was negative. HPO42- and H2O groups in the DCPD structure acted as riveting groups in the interfacial layer and formed Mg-HPO42- and Mg-H2O dipole pairs with Mg respectively through electrostatic interaction and van der Waals forces. The interfacial bonding energy between DCPD/Mg reached its lowest at 60 °C and the relative contents of HPO42- and H2O in the interface layer were the highest at this temperature, which may explain the high corrosion resistance and high bonding force of CaP coatings prepared at this temperature.

A case of tumoral calcinosis in hemodialysis

Dear Editor, Tumoral calcinosis is a rare syndrome which presents as painless, firm, tumor-like masses around the joints leading to pain, and limitation of joint movements. Commonly affected joints are shoulders, elbows, and hip joints. Spinal, temporomandibular joint, metacarpals, and metatarsal involvement have also been described. A 50-year-old female on twice weekly maintenance hemodialysis for the last 3 years presented with complaints of pain and restriction of movements at right hip joint and knee. On examination, range of movements was restricted at the hip joint. On palpation, there were subcutaneous hard nodules in the right hip region. Plain radiographic images of the pelvis were obtained and they showed irregular periarticular masses [Figure 1a]. Plain radiographs of hand, skull, and shoulder joins showed similar lesions [refer to adjoining Figure 1b-d]. On metabolic work, she had parathyroid hormone level of 162 pg/mL, phosphorus of 8.5 mg/dL, calcium of 9.8 mg/dL, albumin of 3.5 g/dL, and Vitamin D level of 29 ng/mL. She was poorly compliant with dietary restrictions and taking phosphate-binding medications. Diagnosis of secondary tumoral calcinosis was made. The patient was managed with phosphate-restricted diet, phosphate-binding medication, and increasing the dialysis frequency from twice weekly to thrice weekly.Figure 1: X-ray images showing (a) irregular peri articular masses around the hip joint. Similar findings were seen in X-ray images of (b) hand (c) skull and (d) shoulder joints as wellTeutschlaender initially described this disease in his studies in 1930’s and it came to be known as Teutschlaender disease.[1] The term tumoral calcinosis was coined by Inclan in 1943.[2] Smack et al. retrospectively studied 122 cases of tumoral calcinosis and proposed a classification system.[3] They classified it as (1) primary normophosphatemic type, (2) primary hyperphosphatemic type, and (3) secondary tumoral calcinosis. Secondary causes include renal insufficiency, hyperparathyroidism, or hypervitaminosis D, with renal insufficiency being the most common identifiable condition. Even though soft-tissue calcifications are common in hemodialysis patients, the prevalence of periarticular masses is low. Most of cases in chronic kidney disease are thought to occur due to the presence of hyperparathyroidism although it may occur in its absence as well. The calcification process results from elevated calcium–phosphorus product with hyperphosphatemia being the most important component. Diagnosis is based on characteristic imaging findings. Imaging typically shows amorphous, cystic, and multi-lobulated deposits in periarticular areas.[4] Computed tomography may show cystic loculi with fluid levels giving rise to sedimentation signs. Treatment of secondary tumoral calcinosis in the setting of renal failure is predominantly medical therapy. Calcium- and phosphate-restricted diets and phosphate binders are used as first-line management. Intravenous pamidronate is also shown to be effective.[5] Partial or total parathyroidectomy can be considered in refractory cases in case hyperparathyroidism is the cause.[6] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

혈액투석 환자의 악력, 혈압, 투석적절도, 투석증상 및 우울 간의 관계

Purpose: This study aimed to determine relationships among handgrip strength (HGS), blood pressure, dialysis adequacy, dialysis symptoms, and depression in hemodialysis patients. Methods: Data from 150 subjects were obtained and analyzed, following a descriptive approach. Results: The average grip strength of the subjects was lower than the standard value for both men and women, and the grip strength differed significantly according to age, gender, education level, monthly income, and BMI. The physiological indicators that showed significant results with the study variables were hemoglobin, serum calcium, and serum phosphorus. The average dialysis adequacy (Kt/V) of the subjects was higher than the normal standard, and there were significant differences according to age, gender, education level, monthly income, dialysis period, number of accompanying diseases, and BMI. The subject’s depression score had a significant negative correlation with dialysis adequacy, and the dialysis symptom score and depression score had a significant positive correlation. Conclusion: General characteristics, dialysis-related characteristics, and physiological indicators of hemodialysis patients were analyzed in detail, and differences between these characteristics and grip strength, blood pressure, dialysis adequacy, dialysis symptoms, and depression were also examined. It is necessary to provide delicate nursing according to the individual characteristics of the patient.

THE IMPORTANCE OF NUTRITIONAL COUNSELING FOR HYPERPHOSPHATEMIA IN MAINTENANCE HEMODIALYSIS PATIENTS

Aim: To assess the impact of dietetic intervention on the nutritional status and calcium–phosphorus metabolism in maintenance hemodialysis (MHD) patients. Material and methods: Six-month longitudinal intervention study of 162 MHD patients selected from one dialysis unit in Romania. They were divided into 4 groups according to serum albumin (SA) level and the comorbid condition of chronic liver disease (CLD). Clinical and biochemical parameters were measured at baseline and 6 months after PNC (personalized nutritional counseling). Nutritional status was assessed by mSGA (modified Subjective Global Assessment) and dietary calorie and protein intake by diet history with the help of 72 h recall method. Nutritional counselling and personalized diets were recommended by the dietician bimonthly for a period of 6 months only to groups I and III (groups with hypoalbuminemia). Results: Comparison of data collected prior PNC (T0) and 6 months after (T6) showed: phosphorus (P) level decreased significantly in all 4 groups: group I- T0 vs. T6 p=0.005, group II: T0 vs. T6 p= 0.002; group III: T0 vs. T6 p=0.001, and group IV T0 vs. T6 p=0.042; serum Ca followed a similar trend; serum parathyroid hormone (PTH) remained stationary; SA level was significantly improved in both nutrition counseling groups (group I: T0 vs. T6 p= 0.001, group III: T0 vs. T6 p=0.001, respectively). Conclusions: Our study suggests that dietetic intervention focused on phosphate and albumin control in MHD patients with hyperphosphatemia and hypoalbuminemia contributes to an improvement in important nutritional parameters and to a positive calcium-phosphorus balance.

Pharmacodynamics and acute toxicity studies of Shangke Jiegu tablet with or without cinnabar

PurposeTo evaluate the function of cinnabar in Shangke Jiegu tablet (SKJGT) via pharmacodynamics and toxicity investigations to determine whether cinnabar should be removed from SKJGT. Materials and methodsThe pharmacodynamic differences between SKJGT and cinnabar-free Shangke Jiegu tablet (CFSKJGT) were systematically compared in five animal models. Anti-inflammatory effects were assessed on ear swelling and paw edema by measuring the degree of swelling in each. Then, the acetic acid-induced writhing reaction and hot-water tail-flick were also evaluated by counting pain reactions. The pharmacodynamic effects on soft tissue contusions were identified through histopathological observation. Chemical markers of fracture healing, including osteocytes and the blood calcium and phosphorus level, were determined via radiographic examination and biochemical assay, respectively. In addition, the maximum dosages of SKJGT and CFSKJGT were tested in mice to compare their toxicities. ResultsSKJGT and CFSKJGT showed anti-inflammation effects (swelling inhibition ratios of 40.8% and 44.0%, respectively), analgesia (pain threshold ratios of 48.2% and 44.1%, respectively, at 60 min in the hot-water tail-flick test), and soft tissue contusion repair compared with the control (p < 0.05), and the degree of swelling inhibition and the number of pain reactions were dose-dependent. SKJGT and CFSKJGT both significantly improved the bone healing in the rat fracture model, as indicated by the increased osteocyte size during weeks 1–6 and elevated blood calcium and blood phosphorus levels (reaching maximum concentrations of 7.5 mmol/L and 6.8 mmol/L, respectively) during weeks 1–2. The maximum doses for the SKJGT and CFSKJGT groups were 9.0 g/kg in the acute toxicity experiment. The seizure rate of the SKJGT group (25.0%) was lower than that of the CFSKJGT group (50.0%) when the toxicity was observed after administration. ConclusionThis is the first report to investigate the pharmacodynamics and acute toxicity of cinnabar in SKJGT. Broadly, this study offers novel, valuable insights into the efficacy of cinnabar in prescribed SKJGT.

Dynamics of biochemical parameters of blood of cows during the dry period for stall keeping

The period of stable keeping of cows is one of the most difficult periods for the body, as it is the most saturated with stressful influences, and precisely due to the lack of solar insolation and exercise, the action of potentially pathogenic microflora and increased gassing of livestock premises, shortage vitamins, micro- and macroelements in feed. Deep calving animals have metabolic disorders without clinical signs. Such a form pathologies can be detected only through biochemical research.The content of total protein was determined by biuret`s method, albumins ‒ by reaction with bromocresol green, activity alanine and aspartate aminotransferase ‒ by the Reitman-Frenkel method, activity alkaline phosphatase ‒ with disodium phenyl phosphate, acid capacity ‒ by Bolshakov-Belyaev technique, carotene content ‒ by photometric method, content of total calcium ‒ by the complexometric method, the content of carotene ‒ photometric method. The purpose of our work was to study the dynamics of protein and mineral meabolism in cows during the dry period for stall keeping. The object of the study was cows (15 heads) of the Holstein breed with a milk yield of 5‒6 thousand kg per lactation for 8‒9 months of pregnancy. It was found that the total protein of the cows organism decreased in the last months of pregnancy during the dry period from 87.25 ± 1.20 to 81.60 ± 1.20 g/l (Р &lt; 0.05), including the globulin fraction from 51.96 ± 2.08 to 43.75 ± 2.07 g/l (Р &lt; 0.05) and other indicators of protein metabolism changed. The g-globulin fraction significantly decreased from 28.53 g/l to 22.97 g/l (Р &lt; 0.01). In our opinion, this is due to a decrease in the activity of the mother's body defenses to prevent the development of a reaction to the fetal tissue, which is a foreign organism. The activity of aspartate aminotransferase decreased by 8.5 months of pregnancy to 150.26 ± 13.59 nM/s·L (Р &lt; 0.01), and then tended to increase to 187.19 ± 9.21 nM/s·L (Р &lt; 0.05). Such a change in the activity of this enzyme in late pregnancy is associated with an increase in the processes of self-renewal of proteins due to transamination, which can be used more intensively by the fetus. The calcium content decreased by 1.14 times during the dry period. This fact, in our opinion, is associated with the intensive development and formation of the fetal skeleton. This is also evidenced by a significant increase in the activity of alkaline phosphatase (1.29 times, Р &lt; 0.01). Changes in total calcium and inorganic phosphorus were strongly correlated (r = 1.0). The results obtained allow us to point out the causes of the identified deviations and offer recommendations for their elimination and correction of animal feeding.