Increased Serum Calcium Research Articles

Cost-effectiveness of plasmapheresis and hemoperfusion in COVID-19 survivors: A six-month follow-up analysis after hospital discharge.

To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge. Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves. A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO2, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO2, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls. While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.

Effect of persistent hypercalcemia on hemoglobin levels after kidney transplantation.

After kidney transplantation, persistent hyperparathyroidism commonly occurs, often alongside increased serum calcium levels. It is reasonable to infer that kidney transplant recipients (KTRs) with hypercalcemia related to persistent hyperparathyroidism are more susceptible to developing anemia. However, reports suggest that hypercalcemia could be a contributing factor to erythrocytosis. Our aim was to assess the effect of persistent hypercalcemia on the trajectory of hemoglobin levels after transplantation. We conducted a retrospective cohort study investigating the trajectory of hemoglobin in 385 KTRs with and without persistent hypercalcemia (free Ca > 5.2 mg/dL). We performed mixed-model analyses adjusting for potential confounders. Persistent hypercalcemia was present in 62% KTRs (56% male, median age 36 (IQR 28 - 48) years, median follow-up 4.1 (IQR 1 - 8.2) years). Compared to KTRs without hypercalcemia, KTRs with persistent hypercalcemia had a mean positive difference in hemoglobin levels of +0.76 g/dL/year (95% CI +0.45 - +1.08, p < 0.001) throughout the follow-up period. Specifically, the change slope was +0.80 (95% CI +0.32 - +1.27, p < 0.001) g/dL/year for males and +0.36 (95% CI +0.16 - +1.08, p < 0.001) g/dL/year for females. Persistent hypercalcemia was significantly associated with post-transplant erythrocytosis according to the WHO (47 vs. 24%, OR 2.8, 95% CI 1.8 - 4.4) and altitude-adjusted criteria (22 vs. 10%, OR 2.5, 95% CI 1.2 - 4.5). The effect of hypercalcemia on hemoglobin levels was consistent after adjusting for confounders, except in KTRs who developed an estimated glomerular filtration rate < 45 mL/min/1.73m2 after transplantation. Persistent hypercalcemia after kidney transplantation was significantly associated with higher hemoglobin levels and an increased risk of developing post-transplant erythrocytosis.

Effects of isoflavone interventions on bone turnover markers and factors regulating bone metabolism in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

This study aimed to assess the impact of isoflavone interventions on bone turnover markers and various biochemical markers of bone metabolism through systematic review and meta-analysis. Four electronic databases, including PubMed, Embase, Scopus, and Cochrane Library, were searched in September 2023 for investigating the effects of isoflavones on bone turnover markers as well as signaling molecules regulating osteoclast differentiation, bone minerals, and hormones regulating bone metabolism in postmenopausal women. The main effect estimates, obtained using a random-effects model, were summarized using the mean difference (MD) or standardized mean difference (SMD), as appropriate. A total of 73 randomized controlled trials were included, comparing an isoflavone intervention to a placebo. Our findings demonstrated that isoflavone interventions significantly reduced bone resorption markers, that is, β cross-linked C-telopeptide of type 1 collagen (β-CrossLaps) (MD = - 0.0943ng/mL; P = 0.0071) and pyridinoline (PYD) (SMD = - 0.9111; P = 0.0247). Moreover, isoflavone interventions positively affected bone mineral parameters by increasing serum calcium levels (MD = 0.3430mg/dL; P = 0.0267) and decreasing serum phosphorus levels (MD = - 0.0648mg/dL; P = 0.0435). Hormones involved in regulating bone metabolism, particularly insulin-like growth factor type 1 (IGF-1), exhibited significant increases following isoflavone interventions (MD = 9.8163ng/mL; P < 0.0001). Subgroup analysis suggested that the effects of isoflavones on bone turnover markers are influenced by factors such as the duration since menopause and the intervention duration. This systematic review and meta-analysis highlight the potential of isoflavone interventions to rectify imbalances in bone remodeling, enhance bone mineral homeostasis, and optimize hormones regulating bone metabolism in postmenopausal women.

Comparison of the Effects of Long-term Hemodialysis and Peritoneal Dialysis Modalities on Left Ventricular Functions.

Hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) affect left ventricular hemodynamics. This study compared the effect of two treatment modalities, CAPD and HD, on left ventricular systolic and diastolic functions in maintenance dialysis patients. A total of 47 patients (24 CAPD and 23 HD) undergoing long-term dialysis were included in the study. Left ventricular functions, left ventricular hypertrophy, and left ventricular geometry were evaluated using echocardiography. The mean age of the patients was 58.6 ± 11.2 years. The mean dialysis time was 125.1 ± 35.2 months. When echocardiographic parameters were examined, left ventricular muscle mass, mass index, E/e' ratios, and global longitudinal strain were significantly higher in the CAPD group. The rates of diastolic dysfunction (66.7% vs. 26.1%) and left ventricular hypertrophy (91.7% vs. 60.9%) were higher in the CAPD group than in the HD group. Dialysis modality CAPD, abnormal global longitudinal strain (GLS), and increased serum calcium were associated with an increased risk of diastolic dysfunction. The study results demonstrated that left ventricle (LV) diastolic dysfunction and deterioration in left ventricular geometry were significantly higher in patients receiving long-term CAPD treatment than for long-term HD treatment.

Responses of laying performance, eggshell quality, calcium, and phosphorus metabolism to feeding patterns and dietary available phosphorus levels in aged laying hens

This study aimed to determine the effects of feeding patterns and dietary available phosphorus levels on laying performance, eggshell quality, calcium, and phosphorus metabolism in aged laying hens. The experiment followed a 3 × 2 factorial arrangement of three feeding patterns (feeding twice a day, 1/2 daily feeding at 8:00, and 1/2 daily feeding at 14:00; disequilibrium feeding twice a day, 1/3 daily feeding at 8:00, and 2/3 daily feeding at 14:00; feeding thrice a day, 1/3 daily feeding at 8:00, 1/3 daily feeding at 14:00, and 1/3 daily feeding at 18:00) and two available phosphorus levels (0.32 %, 0.27 %) was carried out with a total of 528 Hy-Line Brown laying hens aged 62–74 weeks. Each group had 8 replicates of 11 hens. The results revealed that feeding patterns and phosphorus levels significantly interacted with egg production ratios, soft shell and broken egg ratios in weeks 9–12 (P < 0.05). Feeding thrice a day and disequilibrium feeding twice a day significantly improved the equatorial and average eggshell thickness (P < 0.05), and had a trend of increasing eggshell strength at week 12 (P= 0.068). They also significantly increased the effective layer thickness and the calcified layer thickness of the eggshell (P < 0.05). Additionally, feeding thrice a day significantly increased serum calcium content compared with feeding twice a day (P < 0.05), and feeding thrice a day significantly increased the calcium content of the eggshell, mRNA expression level of CaBP-D28k in the uterine compared with the other two feeding patterns (P < 0.05). While disequilibrium feeding twice a day resulted in higher phosphorus content in the excreta compared with the other two feeding patterns (P < 0.05). These results indicated that feeding hens thrice a day with 0.27 % dietary available phosphorus level might improve in laying performance and eggshell quality of aged laying hens.

Short and long-term effects of kidney donation on mineral and bone metabolism

BackgroundLiving kidney donors (LKD) experience an abrupt decline in glomerular filtration rate (GFR) resulting in abnormalities of mineral and bone metabolism (MBD), and this may have implications for skeletal health. We prospectively studied acute and long term MBD adaptation of LKD from two kidney transplant centers (São Paulo, Brazil and Miami, USA).MethodsRenal function and MBD parameters longitudinally after kidney donation (baseline – D0, day 1, 14, 180 and 360 post-operatively) were measured in 74 patients (40 y, 73% female, 54% Brazilian). A subset of 20 donors from Brazil were reassessed after 10 years of nephrectomy.ResultsAt baseline, Brazilian donors presented lower intact FGF23 (20.8 vs. 80.1 pg/mL, P < 0.01) and higher PTH (47.4 vs. 40.1, P = 0.04) than their US counterparts. GFR decreased to 63% of its baseline levels just after donation but improved 10% during the first year. PTH levels increased on D1, returning to baseline levels on D14, while FGF23 remained higher than baseline over the first year. LKD had a significant reduction of serum phosphate on D1, which returned to baseline levels on D180. A higher fractional excretion of phosphate (FEP) was noted since D14. After 10 years of donation, 20 LKD presented a sustained reduction in GFR (74.8 ± 14mL/min). There was a return to baseline in serum FGF23 [21.8 (18–30) pg/mL] and FEP, accompanied by an increase in serum calcium. PTH remained elevated (57.9 ± 18 pg/mL), whereas serum calcitriol and Klotho were lower than before the donation.ConclusionsThe abrupt decline in kidney mass is associated with an increase in PTH and FGF23 that is not explained by phosphate retention. In a long-term evaluation, LKD showed a sustained drop in GFR, with lower serum calcitriol and Klotho, and higher PTH. The effects of these changes should be investigated in further studies.

Effects of active vitamin D analogs and calcimimetic agents on PTH and bone mineral biomarkers in hemodialysis patients with SHPT: a network meta-analysis.

Active vitamin D analogs and calcimimetic agents are primary drugs for patients with secondary hyperparathyroidism. Due to the different pharmacological mechanisms, they have different effects on the level of parathyroid hormone, serum calcium, phosphorus, and bone turnover biomarkers. This study aimed to evaluate the active vitamin D analogs and calcimimetic agents in hemodialysis patients with secondary hyperparathyroidism. We included randomized clinical trials of hemodialysis patients with secondary hyperparathyroidism, comparing active vitamin D analogs to calcimimetic agents or placebo/control. The primary outcome was the change of PTH level from baseline to end-up. The secondary outcome was the change in serum calcium, phosphorus, calcium-phosphorus product, and bone turnover biomarkers. A network meta-analysis method was applied to complete this study. The forest plots reflected statistical differences in the outcomes between active vitamin D analogs and calcimimetic agents. The SUCRA result presented the ranking of impact on the outcomes. Twenty-one randomized clinical trials with 4653 patients were included in this network meta-analysis. Global and splitting-node inconsistencies provided no evidence of inconsistency in this study. There was no statistical difference between two active vitamin D analogs and three calcimimetic agents in the PTH, and phosphorus levels changed. Considering serum calcium level, compared with placebo, calcitriol (9.73, 3.09 to 16.38) and paricalcitol (9.74, 3.87 to 15.60) increase serum calcium. However, cinacalcet (- 1.94, - 3.72 to - 0.15) and etelcalcetide (- 7.80, - 11.80 to - 3.80) reduced the serum calcium, even a joint use of cinacalcet with active vitamin D analogs (- 5.83, - 9.73 to - 1.93). Three calcimimetic agents decreased calcium levels much more than calcitriol and paricalcitol. The same type of drugs was not distinct, with each one affecting the change in calcium level. Cinacalcet reduced calcium-phosphorus product much more than paricalcitol (- 3.66, - 6.72 to - 0.60). Evocalcet decreased calcium-phosphorus product more than cinacalcet (- 5.64, - 8.91 to - 2.37), calcitriol (- 9.36, - 14.81 to - 3.92), and paricalcitol (- 9.30, - 13.78 to - 4.82). Compared with paricalcitol, cinacalcet significantly increases the level of ALP (24.50, 23.05 to 25.95) and bALP (0.67, 0.03 to 1.31). The incidence of gastrointestinal disorders in cinacacet (29.35, 1.71 to 504.98) and etelcalcetide (20.92, 1.20 to 365.68) was notably higher than in paricalcitol. Etelcalcetide (0.71, 0.53 to 0.96) and evocalcet (0.46, 0.33 to 0.64) presented a lower rate of gastrointestinal disorders than cinacalcet. Cinacalcet ranked first in adverse gastrointestinal, nervous, and respiratory reactions. The same kinds of agents perform similar efficacy on the level of PTH, serum calcium, phosphorus, and calcium-phosphorus product. Paricalcitol did not lead to more hypercalcemia than calcitriol. The calcium decrease induced by cinacalcet was not settled even by associating it with active vitamin D analogs. Cinacalcet and evocalcet were superior to calcitriol and paricacitol in reducing calcium-phosphorus product. Calcimimetics induced more gastrointestinal disorders than active vitamin D analogs, especially cinacalcet.

Features of the state of bone tissue in children with cerebral palsy. Part 1. Etiological aspects. A literature review

BACKGROUND: The growth of the human body is the most significant period of development of the bone tissue, because it is during this period that the size, shape, and architectonics of bone are formed against the background of increasing body weight and increasing physical exertion. Considering a number of pathological factors of the underlying disease (alimentary, neurological, hormonal, stress, and physical), bone tissue in children with cerebral palsy grows and develops with deviations from the norm. АIM: To present up-to-date generalized information about the features of bone tissue in children with cerebral palsy to orthopedic traumatologists, neurologists, and physical therapy specialists. MATERIALS AND METHODS: Studies on the problem of bone tissue condition in patients with cerebral palsy were analyzed. Data published over the past 20 years were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language restrictions. RESULTS: In the last 20 years, the number of studies about pediatric osteoporosis has increased. The gold standard for determining the level of bone mineral density is dual-energy X-ray absorptiometry. However, its use in children has presented some difficulties and limitations. In children, the relationship between bone mineral density values and the risk of fractures has not been well studied, which does not allow us to discuss about osteoporosis based on densitometric bone mineral density data alone. In patients with cerebral palsy, a decrease in bone mineral density and bone mass during growth was found. Previous studies showed that the main factors associated with a decrease in bone mineral density in this group of patients include neuroendocrine causes due to growth retardation against the background of CNS damage, alimentary factors, decreased calcium and vitamin D concentrations, systemic use of glucocorticoids, intake of antiepileptic drugs, decreased motor activity, and low muscle mass. Increasing serum vitamin D concentrations does not have a positive effect on bone mass, although increasing serum calcium concentrations is associated with an increase in bone mineral density. CONCLUSIONS: Identifying and correcting factors leading to decreased bone mineral density in children with cerebral palsy can improve bone health in this group of patients. The absence of a relationship between bone mineral density values and the risk of fractures in children with cerebral palsy does not allow us to discuss about osteoporosis based only on bone mineral density densitometric data. There may be more factors leading to an increased risk of bone fractures in children with cerebral palsy that require further study.

Association of serum calcium levels with diabetic kidney disease in normocalcemic type 2 diabetes patients: a cross-sectional study

To explore the association between serum calcium levels within normal ranges and Diabetic Kidney Disease (DKD) in type 2 diabetes patients. In this cross-sectional study, we analyzed clinical data from type 2 diabetes patients admitted to the Endocrinology Department of the Affiliated Hospital of Qingdao University from January 1, 2021, to December 1, 2022. We measured serum calcium levels, corrected for albumin, and screened for diabetes-related complications, including DKD. The association between corrected serum calcium levels and DKD was evaluated using logistic regression, with adjustments made for potential confounders and a generalized additive model (GAM) to explore non-linear relationships, supplemented by subgroup analyses. Among the 3016 patients (52.55% male, 47.45% female), the mean corrected serum calcium was 2.29 ± 0.08 mmol/L. DKD was present in 38.73% of patients. A 0.1 mmol/L increase in corrected serum calcium was associated with a 44% increased risk of DKD (OR = 1.44, 95% CI 1.28–1.61, p < 0.0001). The GAM indicated a linear relationship between corrected serum calcium and DKD risk, consistent across subgroups. Corrected serum calcium levels were linearly associated with DKD risk in type 2 diabetes patients, underlining its potential role in risk assessment. These findings emphasize the clinical importance of monitoring serum calcium levels. However, the need for further prospective studies to confirm these findings is underscored by the study’s cross-sectional design.

Association between serum calcium level and the risk of acute kidney injury in patients with acute myocardial infarction: evidences from the MIMIC-IV database

Objective This cohort study was to assess the association between serum calcium levels and the risk of acute kidney injury (AKI) in acute myocardial infarction (AMI) patients. Methods This study was analyzed using data of 1286 AMI patients aged ≥18 years who stayed in ICU more than 24 h in Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Univariable logistic regression model was established to identify potential covariates. Univariate and multivariable logistic regression models were used to analyze the association between serum calcium and the risk of AKI in patients with AMI. The association between serum calcium and the risk of AKI in patients with AMI was also shown by restricted cubic spline (RCS) plot. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Results The median follow-up time was 1.61 (1.23, 2.30) days, and 436 (33.90%) participants had AKI at the end of follow-up. After adjusting for covariates, elevated level of serum calcium level was related to reduced risk of AKI in AMI patients (OR = 0.88, 95%CI: 0.80–0.98). Decreased risk of AKI was found in AMI patients with serum calcium level of 8.40–8.90 mg/dL (OR = 0.54, 95%CI: 0.34–0.86) or ≥8.90 mg/dL (OR = 0.60, 95%CI: 0.37–0.99). The RCS plot depicted that serum calcium level was negatively correlated with the risk of AKI in patients with AMI. Conclusions AMI patients with AKI had lower serum calcium levels compared with those without AKI. Increased serum calcium level was associated with decreased risk of AKI in patients with AMI.

Serum calcium and mortality in pediatric pneumonia patients admitted to the PICU: a retrospective cohort study

This study investigates serum calcium’s prognostic value in pediatric pneumonia, focusing on its correlation with PICU mortality, to enhance understanding and treatment approaches in this field. Data from 414 pediatric pneumonia patients (2010–2019) admitted to the intensive care units at the Children’s Hospital, Zhejiang University School of Medicine were analyzed. The study utilized restricted cubic spline analysis, Cox proportional hazard regression, and Kaplan–Meier survival curve analysis to assess the relationship between serum calcium levels at admission and PICU mortality risk. After adjusting for multivariate factors, for each 1 mmol/dL increase in serum calcium, the risk of mortality decreased by 24% (HR: 0.76, 95% CI 0.67–0.87). Among the three levels of serum calcium groups, higher serum calcium levels were linked to a 63% reduction in the mortality rate compared to lower levels (HR: 0.37, 95% CI 0.16–0.84). The cumulative hazard estimates of mortality significantly differed across serum calcium groups (log-rank P = 0.032). This association was consistent across diverse subgroups (P for interaction > 0.05). Higher serum calcium levels are associated with decreased PICU mortality in pediatric pneumonia, highlighting its potential as a prognostic marker.

Effect of Swimming Free 50 Meters for Males on Calcium Levels and Some Enzymes of Thyroid and Parathyroid Gland

Study purpose. This study aimed to investigate the effect of swimming free 50 meters on calcium levels and activities of some key enzymes involved in calcium metabolism in males. Materials and Methods. Eleven healthy male adults were selected to participate in the study. They freely swam 50 meters daily for four weeks. A one-group pretest-posttest design was used to evaluate the effect of the swimming intervention on markers of calcium metabolism. Measurements were taken for participants before and after swimming. Fasting blood samples were collected before and after swimming to measure serum calcium levels as well as the activities of alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), 5'-nucleotidase, thyroid stimulating hormone (TSH) and parathormone (PTH) by standard enzymatic methods. Results. After four weeks of swimming free 50 meters daily, serum calcium levels showed a statistically significant increase compared to baseline (p &lt; 0.05). The activities of ALP, AST, and ALT were significantly higher post-intervention (p &lt; 0.05 for all enzymes). There were no significant changes in 5'-nucleotidase, TSH, and PTH activities. Conclusions. The results indicate that swimming free 50 meters daily for four weeks increases serum calcium levels, likely through enhanced bone resorption as suggested by the elevated activities of ALP, AST, and ALT. However, there were no significant effects on thyroid and parathyroid functions as assessed by TSH and PTH.

Effects of different production systems on health, zootechnical and metabolic parameters in Holstein calves in the extreme south of Brazil

The aim of this study was to evaluate the incidence of diseases as well as metabolic and zootechnical parameters in Holstein calves maintained in individual or collective housing systems in the extreme south of Brazil. One hundred calves were included immediately after birth and monitored for 90 days. Animals were randomly divided into two groups: individual stalls group (ISG; n=50) and collective stalls group (CSG; n=50). ISG calves were individually housed in 1.2m² wood pens and received 6 L of milk/day and concentrate food and water ad libitum for 90 days. Calves in the CSG were housed in groups of up to 25 animals, in a total of two stalls containing one animal per 3 m2. CSG calves received up to 8 L of milk/day at 0-15 days, milk ad libitum at 15-40 days, 7.2 L of milk. /day at 40-60 days, and gradual weaning at 60-90 days with concentrate food and water ad libitum, using an automatic feeder. In both groups, Zootechnical parameters (weight, thoracic perimeter, height at the withers, and rump width) were measured weekly during the first 28 days and once every 15 days until weaning. Blood samples were retrieved weekly during the first 28 days. Metabolic parameters evaluated in this study were total calcium, beta-hydroxybutyrate (BHBA), free fatty acids (FFA), and glucose. The animals were monitored daily for clinical signs of diseases diarrhea and respiratory symptoms. General morbidity was higher in CSG 92% compared to ISG 74% (p&lt;0.05). We observed increased diarrhea-related morbidity and a higher rate of recurrence in the ISG (50% and 60%, respectively; p&lt;0.05) compared to those in the CSG (both 20%, p&lt;0.05 between groups). The morbidity due to bronchopneumonia was higher in the CSG (92%) than in the ISG (74%, p&lt;0.05). Recurrence of bronchopneumonia and mortality were similar between groups (p&gt;0.05). Glucose, FFA, and BHBA concentrations were higher in the ISG (p&lt;0.05) and total calcium higher in CSG (p&lt;0.05). Finally, the weight and thoracic perimeter were higher in the CSG than those in the ISG, whereas the height and, rump width, at the withers was higher in the ISG than that in the CSG (p&lt;0.05). In conclusion, animals raised in a collective system with automatic feeders exhibited less diarrhea and increased serum calcium as well as improved zootechnical development, although they had a higher incidence of bronchopneumonia.

Renal Artery Coil Embolization as an Endovascular Approach for Establishing a Rabbit Model of Chronic Kidney Disease

PurposeTo investigate the safety and feasibility of renal artery coil embolization for establishing chronic kidney disease (CKD) in rabbits. Materials and MethodsTen male adult New Zealand rabbits underwent renal artery coil embolization. Initially, the main renal artery on 1 side was completely embolized, followed by embolization of approximately two-thirds of the primary branches of the contralateral renal artery 1 week later. Four rabbits were randomly chosen for sacrifice at 4 weeks after embolization, whereas the remaining 6 were sacrificed at 8 weeks after embolization. The assessment encompassed the animals’ general condition, angiography, biochemical parameters, inflammatory markers, and histopathological examination of the kidneys and hearts. ResultsFour weeks after embolization, serum creatinine level showed a substantial increase (2.4 mg/dL [SD ± 0.6]; P = .009 vs baseline), with a subsequent 4.12-fold elevation at 8 weeks after embolization (4.9 mg/dL [SD ± 1.4]; P < .001 vs baseline). Additionally, considerable increases in serum blood urea nitrogen, calcium, and potassium ions were observed at 8 weeks after embolization (58.3 mg/dL [SD ± 19.0]; P < .001 vs baseline; 23.1 mg/dL [SD ± 4.4]; P < .001 vs baseline; and 6.3 mEq/L [SD ± 0.7]; P < .001 vs baseline, respectively). The completely embolized kidney exhibited notable atrophy, severe fibrosis, and cortical calcification, whereas the contralateral partially embolized kidney displayed compensatory hypertrophy, along with glomerulosclerosis, tubular dilation, tubular casts, and interstitial fibrosis. ConclusionsRenal artery coil embolization proved to be effective and safe for establishing a CKD model in rabbits.

Microalgae polyphosphate nanoparticles deliver bioavailable calcium against phytate antagonism: Ex vivo and in vivo studies

Biogenic nanoparticles are promising carriers to deliver essential minerals. Here, calcium-enriched polyphosphate nanoparticles (CaPNPs) with a Ca/P molar ratio > 0.5 were produced by Synechococcus sp. PCC 7002 in the growth medium containing 1.08 g/L CaCl2, and had nearly spherical morphologies with a wide size distribution of 5–75 nm and strongly anionic surface properties with an average ζ-potential of –39 mV, according to dynamic light-scattering analysis, transmission and scanning electron microscopy, and energy-dispersive X-ray spectroscopy. The ex-vivo ligated mouse ileal loop assays found that calcium in CaPNPs was readily available to intestinal absorption via both ion channel-mediated and endocytic pathways, specifically invoking macropinocytic internalization, lysosomal degradation, and transcytosis. Rat oral pharmacokinetics revealed that CaPNPs had a calcium bioavailability approximately 100 % relative to that of CaCl2 and more than 1.6 times of that of CaCO3. CaPNPs corrected the retinoic acid-induced increase in serum calcium, phosphorus, and bone-specific alkaline phosphatase, and decrease in serum osteocalcin, bone mineral content/density, and femoral geometric parameters with an efficacy equivalent to CaCl2 and markedly greater than CaCO3. In contrast to CaCl2, CaPNPs possessed desirable resistance against phytate’s antagonistic action on calcium absorption in these ex vivo and in vivo studies. Overall, CaPNPs are attractive as a candidate agent for calcium supplementation, especially to populations on high-phytate diets.

Effect of Feeding a Calcium Chloride Supplement on Sow Stillbirth Rate

The present study was undertaken to determine the effect of daily calcium chloride (CaCl2) supplementation from day of entry into the farrowing house until day of farrowing (6.4 ± 0.3 d) on stillbirth rates. Landrace × Large White sows (parities 4 to 6; n = 53) were offered 40 g/d CaCl2 (n = 28) or served as controls (n = 25). The morning before their estimated farrowing date, a blood sample was obtained from 25 sows for calcium measurement and a urine sample from 22 sows for pH measurement. The feeding of CaCl2 decreased urinary pH compared to the control group (p &lt; 0.001), indicative of an induced metabolic acidosis, but there was no effect of feeding CaCl2 on serum calcium concentrations or the incidence of stillbirths. Nonetheless, regardless of treatment, sows with higher serum calcium concentrations (&gt;2.5 vs. &lt;2.5 mmol) or lower urine pH (&lt;7.0 vs. &gt;7.0) had fewer stillborn piglets (p &lt; 0.001 for both). While showing that low serum calcium levels will increase stillbirth rates, our data indicate that the administration of 40 g/d CaCl2 for 6 d prior to farrowing was not sufficient to increase serum calcium or decrease stillbirth incidence.

Association between thymic hyperplasia and serum calcium level in Graves’ disease

BackgroundGraves' disease increases bone resorption in hyperthyroidism, leading to elevated serum calcium levels and a negative bone balance. Thymic hyperplasia is observed in some Graves' disease patients. What's more, there have been a few reports of increased serum calcium and severe osteoporosis induced by Graves’ disease with thymic hyperplasia. It remains unclear whether Graves’ disease with thymic hyperplasia is associated with higher serum calcium levels. Our study aimed to investigate the possibility of elevated serum calcium levels and aggravated bone mobilization in Graves’ disease patients with thymic hyperplasia.MethodsNewly diagnosed and untreated patients with Graves' disease (n = 96) were enrolled. They were divided into two groups based on the incidental detection of thymic hyperplasia during imaging. Albumin, alkaline phosphatase, calcium, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, and thyrotrophin receptor antibody (TRAb) were measured, and a computerized tomography of the chest was obtained.ResultsPatients with Graves’ disease who had thymic hyperplasia were notably younger (P=0.018) and exhibited higher serum calcium levels (P=0.001) compared to those with Graves’ disease without thymic hyperplasia. In the multiple regression analysis, thymic hyperplasia, TRAb, and female gender were significant variables associated with elevated serum calcium levels in patients with Graves' disease, collectively accounting for 31.7% of the variation in serum calcium.ConclusionsGraves’ disease patients with thymic hyperplasia showed higher serum calcium levels. thymic hyperplasia, TRAb, and female gender were found to be correlated with increased serum calcium levels in Graves’ disease, suggesting a potential association between thymic hyperplasia and bone mobilization in Graves’ disease.

Plasma Ionic Levels in Patients with Septic Shock Before and After Treatment with Different Antioxidants

Background: Septic shock is the most severe form of sepsis, and electrolyte levels have been associated with septic shock in intensive care units, although it has been underdiagnosed Objective: This study aimed to evaluate plasma ionic levels in patients with septic shock before and after treatment with different antioxidants. Methods: Plasma ionic levels were measured in 129 healthy control patients, 14 with septic shock without treatment, and 51 under treatment with four different antioxidant therapies. Results: We found essential differences when comparing the plasma ionic levels of K+, Ca2+ y Mg2+ between the control groups versus both groups with sepsis at the time of hospital admission. In patients with septic shock, there is a decrease in the serum levels of ionized Na+, K+, Cl- and Ca2+ and Mg2+ Antioxidant treatment as an adjunct to the standard management of patients with septic shock increases the electrolyte deficit. Conclusions: The correction of the magnesium deficit also increases serum calcium and potassium levels. Managing antioxidant therapy in patients with septic shock within the first hours of admission can help improve their ionic levels of Ca2+ y Mg2+, mainly in patients with lung damage.

Postbiotic derived from Bacillus subtilis ACCC 11025 improves growth performance, mortality rate, immunity, and tibia health in broiler chicks.

The objective of this study was to evaluate the effects of dietary supplementation of postbiotics on growth performance, mortality rate, immunity, small intestinal health, tibia characteristics, and hematological parameters of broiler chicks. he postbiotics were derived from Bacillus subtilis ACCC 11025. A total of 480 day-old Arbor acre broiler chicks (52.83 ± 1.38 g) were used in a 42-day study and were randomly allocated into four groups. Each group comprised 6 replicate cages, each containing 20 birds. Dietary treatments were based on a basal diet, supplemented with postbiotics at concentrations of 0.000%, 0.015%, 0.030%, or 0.045%. The results demonstrated an improvement in growth performance, antibody titers against avian influenza virus and Newcastle disease virus, serum albumin levels, and serum total protein levels, as well as a reduction in mortality rate among broiler chicks with increasing levels of postbiotic supplementation. The most significant effect were observed in the group receiving 0.015% postbiotics. Furthermore, a dose-dependent enhancement in tibia weight and tibia weight to length ratio, coupled with a reduction in the robusticity index, was noted. The most favorable outcomes for tibia health were observed in the group receiving 0.030% postbiotics. This improvement in tibia health corresponded to a linear increase in serum calcium and inorganic phosphorus contents. In summary, supplementing broiler chicks with 0.015% postbiotics effectively enhances immunity, leading to improved growth performance and reduced mortality rates. Additionally, a postbiotic dose of 0.030% is suitable for optimizing tibia health.

The impact of accessibility to non-calcium-based phosphate binders and calcimimetics on mineral outcomes in patients receiving maintenance hemodialysis: A 10-year retrospective analysis of real-world data.

Hyperphosphatemia and hyperparathyroidism are common in end-stage kidney disease and are associated with poor outcomes. In addition to adequate dialysis, medications are usually required for optimum control of serum phosphate and parathyroid hormone (PTH) levels. The use of calcium-based phosphate binders (CBPBs) and active vitamin D is associated with an increase in serum calcium and worsening vascular calcification. To overcome these limitations, non-calcium-based phosphate binders (NCBPBs) and calcimimetics have been developed. However, the coverage for these new medications remains limited in several parts of the world due to the lack of patient-level outcome data and cost. The present study examined the differences in mineral outcomes between two main categories of healthcare programs that provided different coverage for medications used to control mineral and bone disorders (MBD). The Social Security/Universal Coverage (SS/UC) program covered only CBPBs and active vitamin D, whereas the Civil Servant/State Enterprise (CS/SE) program provided coverage of CBPBs, active vitamin D, NCBPBs, and calcimimetics. This 10-year retrospective cohort study examined the differences in mineral outcomes between two healthcare programs in maintenance hemodialysis patients. The differences in serum calcium, phosphate, and PTH levels, as well as the aortic arch calcification score, were analyzed according to dialysis vintage by linear mixed-effects regression analyses. The difference in the composite outcome of severe hyperparathyroidism and parathyroidectomy was analyzed by the Cox-proportional hazard regression model. 714 patients were included in the analyses (full cohort). Of these patients, 563 required at least one type of medication to control MBD (MBD medication subgroup). Serum calcium, phosphate, and the proportions of patients with hypercalcemia and hyperphosphatemia were substantially higher in the SS/UC group compared with the CS/SE group after appropriate adjustments for confounders in both the full cohort and the MBD medication subgroup. These findings were confirmed in propensity-score matched analyses. Higher parathyroid hormone levels and a higher rate of the composite endpoint of severe hyperparathyroidism and parathyroidectomy were also observed in the SS/UC group. A more rapid progression of aortic arch calcification was suggested in the SS/UC group, but between-group changes were not significant. Patients under the healthcare program that did not cover the use of NCBPBs and calcimimetics showed higher serum calcium and phosphate levels and a more rapid progression of hyperparathyroidism. The difference in the progression of vascular calcification could not be confirmed in the present study.