Plasma Albumin Levels Research Articles

A reappraisal of measured voriconazole concentration based on plasma albumin concentration during therapeutic drug monitoring

Background: The unbound fraction of voriconazole can be elevated due to a decreased plasma albumin concentration. Given its nonlinear pharmacokinetic profile, this elevation can cause adverse effects even when the total voriconazole concentration is within the therapeutic window. This study investigated the factors affecting the plasma protein binding (PPB) of voriconazole and developed a method for the reappraisal of measured voriconazole concentration based on plasma albumin concentration. Methods: An observational retrospective study was performed on adult patients receiving voriconazole and therapeutic drug monitoring (TDM) from January 2019 to December 2020 at the First Affiliated Hospital of Wenzhou Medical University. The unbound voriconazole in plasma samples was separated using high-throughput equilibrium dialysis. Total voriconazole and unbound voriconazole concentrations were determined using liquid chromatography-tandem mass spectrometry. A Pearson correlation analysis was performed to analyze the correlations between voriconazole PPB and plasma albumin concentration, liver function, and concomitant medication. Results: A total of 193 cases with 470 voriconazole plasma samples were included. The median plasma concentration of voriconazole was 2.78 [1.56, 4.40] mg/L, median concentration of unbound voriconazole was 1.34 [0.61, 2.18] mg/L, and median binding rate of voriconazole PPB was 51.45% [45.53%, 57.89%]. The Pearson correlation analysis showed that voriconazole PPB was positively correlated with plasma albumin concentration (R = 0.664, P < 0.001). The current TDM window of voriconazole is defined as a total trough concentration within 1 to 4.5 mg/L, assuming voriconazole PPB of 50%. However, fluctuations in plasma albumin levels were found to have affected the unbound fraction of voriconazole, resulting in different responses or toxicity despite the measured voriconazole concentration being within the therapeutic window. Therefore, we developed a formula to amend the measured concentration of voriconazole to reflect the influence of a fluctuation in plasma albumin levels. Conclusion: Plasma albumin levels can affect voriconazole PPB and thus change the unbound fraction of voriconazole. An adjustment to the measured total voriconazole concentration based on plasma albumin concentration is needed during TDM. Keywords: Plasma albumin, voriconazole, therapeutic drug monitoring

Effect of dietary levels of folic acid on growth performance, blood biochemistry, antioxidant capacity, and immunity of juvenile largemouth bass, Micropterus salmoides

AbstractTo obtain the optimal requirement of dietary folic acid (FA) in feed of juvenile largemouth bass, Micropterus salmoides, five experimental diets were prepared with 0, 0.5, 1.5, 4.5, and 13.5 mg/kg of supplemental FA in the basal practical diet (measured FA value <0.18 mg/kg in the basal diet) and fed to juvenile largemouth bass with an initial body weight of (14.49 ± 0.06) g for 7 weeks. The results showed that the weight gain rate and specific growth rate of the experimental fish in each FA supplementation group were higher than those in the control group to varying degrees and reached maximum values at 1.5 mg/kg in the experimental group, which were significantly higher than those in the FA‐free group; the increase in the addition of FA to the diet significantly reduced the visceral to body ratio (visceral somatic index), liver to body ratio, and relative intestine weight. The addition of ≥0.5 mg/kg FA to the feed significantly increased the whole fish protein content. The hemoglobin content and hematocrit of whole blood cells were significantly increased in the fish group supplemented with 0.5–1.5 mg/kg FA, and the addition of 0.5 mg/kg FA significantly increased the number of red blood cells. Plasma total protein and albumin levels increased and then decreased with the addition of FA, reaching a maximum at 1.5 mg/kg, and differed significantly from the FA‐free group. The addition of 0.5 mg/kg and more of FA significantly decreased plasma alanine transaminase (GPT) activity and improved liver GPT activity, the addition of 0.5 mg/kg and more of FA significantly decreased serum malonaldehyde activity, 0.5 mg/kg of FA significantly increased total hepatic antioxidant capacity, 1.5 mg/kg of FA significantly increased hepatic catalase and head kidney lysozyme activity. The addition of 0.5 mg/kg and above of FA significantly reduced liver glycogen content. In conclusion, the addition of FA to the diet significantly improved the growth performance, hematopoiesis, metabolism of protein and carbohydrate, antioxidant capacity of the liver, and protected liver health of juvenile largemouth bass. Regression analysis based on growth performance showed that the optimal amount of FA in the feed of juvenile largemouth bass was 1.42–1.46 mg/kg.

Effect of polysaccharides derived from brown macroalgae Sargassum dentifolium on growth performance, serum biochemical, digestive histology and enzyme activity of hybrid red tilapia

The present trial conducted to examine the impact of dietary red seaweeds, Sargassum dentifolium polysaccharides supplementation on growth induces, hematological and histological indicators of the hybrid red tilapia Oreochromis mossambicus × Oreochromis niloticus fingerlings. A total of 240 hybrid red tilapia fingerlings with an average body weight of 7.50 ± 0.01 g were divided into four experimental treatments (three replicates each). Four identical isonitrogenous isoenergetic diets except the variation of polysaccharide (SP) levels were formulated. The basal experimental diet (control diet) had no seaweed polysaccharide added (SP0). Diets 2–4 (SP1; SP2 and SP3) was formulated to contained seaweed polysaccharide at levels of 10, 20, and 30 g/kg diet, respectively. Growth performance and feed utilization efficiency of hybrid Red tilapia were significantly (P ≤ 0.05) higher in all treatments receiving SP supplemented-diets than the control diet. The red blood cells (RBCs), hemoglobin (Hb) and hematocrit (Hct, %) values differed significantly (P ≤ 0.05) between the control and fish fed various SP supplemented diets. Considering the dietary SP supplementation, a clear higher trend values of RBC was observed with increasing dietary SP inclusion. Lipase activity recorded the highest values with the fish fed diet supplemented with SP at a level of 20 g/kg-1 associated with the lower significant values amylase activity compared to other treatments. Dietary SP supplementation had no effect on total plasma protein, albumin and globulin levels. Fish fed SP2 diet had an increase in GOT, triglycerides. Fish fed SP3 recorded the lowest value of total cholesterol and LDL when compared to other diets. No abnormal or histological changes were detected in sections of liver, stomach and intestine of red tilapia fed different dietary supplemented with SP levels. The findings of current trial revealed that hybrid Red tilapia fed diets containing red seaweeds, polysaccharides for 12 weeks had enhanced performance, feed conversion ratio and hematological indices.

Clinical characteristics of dogs presenting with vomiting as a gastrointestinal sign of chronic enteropathy

Vomiting is a major gastrointestinal (GI) sign of chronic enteropathy (CE) in dogs. Previous studies have reported clinical characteristics of dogs with CE, who developed diarrhea with or without vomiting as GI signs. However, to characterize clinical features of dogs with CE appropriately, dogs presenting with vomiting without diarrhea should be included in the analysis. Thus, this study aimed to characterize clinical features and outcomes of dogs that presented with vomiting without diarrhea. Based on their presenting GI signs, we retrospectively classified 66 dogs with CE into “Vomiting”, “Diarrhea”, or “Vomiting and diarrhea” groups and compared clinical and histological characteristics of each group. We found that 18 of the 66 dogs with CE (27%) presented with vomiting without diarrhea as a GI sign. Compared to the other 2 groups, the Vomiting group was significantly associated with food-responsive enteropathy (FRE), Beagle, lower clinical severity scores, higher plasma albumin levels, and higher histological scores for eosinophils in the duodenal lamina propria according to the univariate analysis. The multivariate analysis revealed that FRE and higher histological scores for eosinophils in the duodenal lamina propria were significant variables in the Vomiting group. Moreover, the survival time was the longest in the Vomiting group among dogs with CE. These findings are of clinical significance as they indicate that presenting with vomiting without diarrhea may not only be helpful in differentiating FRE from the other types of CE, but also in predicting the prognosis.

Addition of essential oil from Lippia sidoides to the diet of tambaqui: An analysis of growth, metabolic and blood parameters, and intestinal enzymes

Plant essential oils can benefit fish growth and health when incorporated into fish diets. This study aimed to evaluate the effect of dietary supplementation of essential oil from Lippia sidoides (EOLS) on growth performance, hematological and biochemical variables, and digestive enzymes in tambaqui (Colossoma macropomum) juveniles. Five diets with different levels of EOLS—0.0 (control), 0.25, 0.50, 1.00, and 1.50 mL kg diet−1— were evaluated for 60 days. Carvacrol was the major chemical compound (44.50%) of EOLS. Supplementation of 0.50 mL EOLS kg diet−1 improved growth performance and increased hematocrit, hemoglobin rate, mean corpuscular hemoglobin concentration, plasma glucose, liver, and muscle glycogen values in juveniles. The tambaqui fed a diet supplemented with 1.00 or 1.50 mL EOLS kg−1 increased plasma triglycerides, albumin, lysozyme, and alanine aminotransferase levels, in addition to intestinal amylase and lipase activity. As the EOLS concentration in the diet increased, intestinal alkaline protease activity was reduced. In conclusion, the addition of 0.50 to 1.00 mL EOLS kg diet−1 is a promising alternative for tambaqui juveniles, as it has been shown to improve growth, metabolism, hematological parameters, and plasma lysozyme and intestinal amylase and lipase activity.

An International Retrospective Observational Study of Liver Functional Deterioration after Repeat Liver Resection for Patients with Hepatocellular Carcinoma.

Simple SummaryFor 657 cases of segment or less repeat liver resection with results of plasma albumin and bilirubin levels and platelet counts before and 3 months after surgery, the indicators were compared before and after surgery. There were 268 open repeat after open and 224 cases laparoscopic repeat after laparoscopic liver resection. The background factors and liver functional indicators before and after surgery, and the changes were compared between both groups. Plasma levels of albumin (p = 0.006) and total bilirubin (p = 0.01) were decreased, and ALBI score (p = 0.001) indicated worse liver function after surgery. Though laparoscopic group had poorer performance status and liver function, changes of the values and overall survivals were similar between both groups. Plasma levels of albumin and bilirubin and ALBI score could be the liver functional indicators for liver functional deterioration after liver resection. The laparoscopic group with poorer conditions showed a similar deterioration of liver function and overall survival to the open group.Whether albumin and bilirubin levels, platelet counts, ALBI, and ALPlat scores could be useful for the assessment of permanent liver functional deterioration after repeat liver resection was examined, and the deterioration after laparoscopic procedure was evaluated. For 657 patients with liver resection of segment or less in whom results of plasma albumin and bilirubin levels and platelet counts before and 3 months after surgery could be retrieved, liver functional indicators were compared before and after surgery. There were 268 patients who underwent open repeat after previous open liver resection, and 224 patients who underwent laparoscopic repeat after laparoscopic liver resection. The background factors, liver functional indicators before and after surgery and their changes were compared between both groups. Plasma levels of albumin (p = 0.006) and total bilirubin (p = 0.01) were decreased, and ALBI score (p = 0.001) indicated worse liver function after surgery. Laparoscopic group had poorer preoperative performance status and liver function. Changes of liver functional values before and after surgery and overall survivals were similar between laparoscopic and open groups. Plasma levels of albumin and bilirubin and ALBI score could be the indicators for permanent liver functional deterioration after liver resection. Laparoscopic group with poorer conditions showed the similar deterioration of liver function and overall survivals to open group.

Impact of Kangaroo Mother Care Intervention on Immunological and Pulmonary Functions of Preterm Infants during Breastfeeding.

Objective Preterm infants (PTIs) are prone to respiratory failure or other diseases due to immature organ development and poor immunological function. Herein, the effects of Kangaroo Mother Care (KMC) on the immunological and pulmonary functions of PTIs during breastfeeding were investigated in this study. Methods The study recruited 86 delivery women and their PTIs with preterm pregnancy outcomes, consisting of 46 cases receiving breastfeeding plus KMC intervention (KMC group) and 40 cases receiving breastfeeding plus routine care (control group). The time of first lactation, time of first breastfeeding, and duration of first breastfeeding were observed in both cohorts. The breastfeeding status was assessed using the LATCH system. Maternal psychological status was evaluated by the breastfeeding self-efficacy scale (BSES) and self-rating anxiety/depression scale (SAS/SDS). The growth and development of PTIs were recorded, and the levels of postalbumin (PA), transferrin (TRF), plasma albumin (ALB), immunoglobulin (Ig) A, IgG, IgM, and complement C3 and C4 were measured. The tidal volume (VT), tidal volume per kilogram (VT/kg), minute volume (MV), and minute volume per kilogram (MV/kg) were detected using a pulmonary function tester. Results The KMC group presented shorter time of first lactation and first breastfeeding than the control group, with longer duration of first breastfeeding (P < 0.05). After intervention, the BSES scores of delivery women were increased, while the SAS and SDS scores were decreased, with more notable improvements in the KMC group (P < 0.05). The levels of PA, TRF, ALB, IgA, IgG, VT, and MV were elevated in PTIs in both groups, with more evident increase in the KMC group than in the control group (P < 0.05). A better growth of PTIs was found in the KMC group than the control group (P < 0.05). Conclusions The study demonstrated that KMC intervention during breastfeeding could benefit PTIs specifically regarding their immunological and pulmonary functions.

Kwashiorkor - New evidence in the puzzle of oedema formation.

Kwashiorkor, a type of severe malnutrition associated with oedema, has been known for centuries but its mechanism remains elusive.1 The low level of plasma albumin and the associated decreased plasma oncotic pressure has been for years the main explanation of oedema of kwashiorkor: an excess fluid flow from the capillaries to the interstitium was assumed to result from an imbalance of Starling's forces.2 This mechanism seems plausible, as a low level of plasma albumin is a hallmark of kwashiorkor3 and the Starling's principle shows that plasma oncotic pressure, largely determined by plasma albumin, is amongst the factors influencing fluid flow from the capillaries towards the interstitium.

Debating capabilities of biochemical markers of liver function in patients with alcoholic liver cirrhosis

Introduction. The diagnosis of alcohol-related liver disease is limited by the lack of a tool to reliably identify whether the present deterioration in the patient’s condition is due to alcohol consumption or other causes.Purpose. to conduct a comparative assessment of the clinical and diagnostic significance of liver function biochemical indicators (AST, ALT, GGT, ALP) and their calculated derivatives (AST/ALT, GGT/ALP, GGT/GGTn, ALP/ALPn) as markers of alcohol consumption in patients with alcoholic liver cirrhosis.Material and methods. The observational study included 112 men over 18 years of age with alcohol-related liver cirrhosis. The patients were assessed the severity of liver cirrhosis according to the Child-Pugh scale, performed general and biochemical blood tests, coagulation test, assessment of the fact of alcohol consumption by the level of phosphatidylethanol. An analysis was made of the relationship between alcohol consumption and changes in laboratory parameters of liver function, with the determination of their sensitivity and specificity.Results. Patients with Child-Pugh B cirrhosis who consumed alcohol on phosphatidylethanol had higher levels of plasma albumin, GGT, and lower values of creatinine, direct and total bilirubin, urea, and aPTT compared with patients who did not drink alcohol (p &lt; 0.05). Alcohol-drinking patients with class C cirrhosis have higher ALT levels compared with abstinent patients with the same severity of cirrhosis (p &lt; 0.05). The relationship between the fact of alcohol consumption, determined by the level of phosphatidylethanol, and the ratio of GGT of patients to the normal GGT value, as well as between the ratio of GGT to alkaline phosphatase and the degree of increase in GGT, turned out to be statistically significant. To assess the fact of alcohol consumption, the level of serum GGT &gt; 65 IU/ l (75.5%) has the highest sensitivity, the highest specificity is the ratio of the patient’s GGT to the normal value of GGT &gt; 2 (82.9%).Conclusion. Compared with the known 100% sensitivity and &gt; 92% specificity of Peth as a alcohol biomarker, among the biochemical indicators of liver function and their calculated derivatives, GGT &gt; 65 IU/l have the greatest sensitivity or specificity (respectively, 75.5% and 65%) and GGTnorm. &gt; 2 (37.7% and 82.9%, respectively), which makes it possible to use the totality of these parameters as an indicator of the continued impact on the patient of the main etiological factor of alcohol-related liver cirrhosis in the routine practice of most medical organizations of the Russian Federation.

Frailty in Diabetic Subjects during COVID-19 and Its Association with HbA1c, Mean Platelet Volume and Monocyte/Lymphocyte Ratio

Background: Frailty is associated with increased risk of hospitalization in diabetic patients. Both SARS-CoV-2 pandemic and type 2 diabetes mellitus contribute to the frailty. In this study we aimed to observe clinical and laboratory indices of the diabetic subjects during COVID-19 pandemic who were either frail or not according to Edmonton frail score. Material and methods: During the pandemic era, 100 consecutive patients with type 2 diabetes mellitus divided into two groups either as frail or non-frail according to the Edmonton Frail Scale scores. Laboratory and clinical features of the frail and non-frail subjects were compared. Results: Frail patients were older than the non-frail diabetics. Blood urea, serum creatinine, eGFR, plasma albumin, total cholesterol, triglyceride, HbA1c, mean platelet volume (MPV), and monocyte lymphocyte ratio (MLR) levels of the frail and non-frail groups were significantly different. Moreover, Edmonton frail score was significantly and positively correlated with blood urea, serum creatinine, MLR, MPV, HbA1c and inversely correlated with eGFR and plasma albumin levels. Conclusions: We think that HbA1c, MPV and MLR could be surrogate markers of frailty in diabetic elderly during COVID-19 outbreak. Strategies to keep them in normal range do not only improve diabetes control but also reduce the risk of frailty in this population.

Evaluation of body condition, daily milk production and biochemical parameters during the postpartum period according to calving season in Montbeliard dairy cows reared in the semi-arid region – Algeria

The aim of this study was to evaluate the effect of calving season on postpartum changes of certain blood metabolites and minerals and of the body condition score evaluation (BCS) in Montbeliard dairy cows reared under semi-arid conditions. Blood samples were collected from 74 clinically healthy dairy cows of 10 semi-intensive Algerian dairy herds once month during a whole year. Animals were grouped according to the occurrence of their calving to four different seasons (autumn, winter, spring and summer). Albumin, urea, glucose, total cholesterol, calcium, phosphorus and magnesium plasma levels were analysed using the colorometric method adapted to each biochemical parameter. One-way repeated measures analysis of variance (ANOVA) showed a significant effect of season (P&amp;lt;0.05, P&amp;lt;0.01 and at P&amp;lt;0.001) on all parameters, except BCS. The highest plasma concentrations of urea nitrogen, albumin, total cholesterol, and phosphorus were recorded in summer, though calcium was significantly lower during this period. A significant negative correlation was found between blood glucose, total cholesterol and phosphorus during winter calving, urea nitrogen in spring calving, and magnesium and calcium in summer calving. The results of this study highlight the evolutionary pattern of blood biochemical metabolites and electrolytes, BCS and daily milk production of Montbeliard dairy cows during the postpartum period according to calving season. They provide reliable information to assess the risk of metabolic activity failures during these very important productive stages, i.e., open days, ascending and peak production periods.

Inflammation Affects Liver Function and the Metabolism of Voriconazole to Voriconazole-N-Oxide in Adult and Elderly Patients.

Background: The inner association of inflammation with voriconazole (VCZ) metabolism has not been fully investigated. We intend to investigate the effects of inflammation on liver function, VCZ trough concentration (C0), C0/dose ratio and the ratio of VCZ to VCZ-N-oxide concentration (C0/CN) in adult and elderly patients. Methods: A single-center retrospective study was conducted among patients who were treated in our hospital between January 2018 and December 2021. For each eligible patient, demographic details, medical history, laboratory parameters, procalcitonin (PCT), C reactive protein (CRP), and interleukin-6 (IL-6) were collected from the medical chart. VCZ CN, TNF-α, IL-1β, IL-8, and IL-10 concentrations were detected in blood samples. Results: A total of 356 patients were included in our study, with 195 patients in the adult cohort (<60 years) and 161 patients in the elderly cohort (≥60 years). In adult patients, CRP and IL-8 levels showed moderate association with VCZ C0/CN ratio (CRP: r = 0.512, p < 0.001; IL-8: r = 0.476, p = 0.002). IL-6 level shallowly associated with VCZ C0/CN ratio both in adult and elderly patients (r = 0.355, p = 0.003; r = 0.386, p = 0.001). A significantly higher VCZ C0, C0/dose ratio and C0/CN ratio was observed in adult patients with severe inflammation compared with patients with moderate inflammation and no to mild inflammation, as reflected by PCT levels (p < 0.05). However, there was no significant difference observed among different inflammation degrees in elderly patients. Lower albumin (AL) and higher total bilirubin (TBIL) were observed along with the degree of inflammation in both adult and elderly patients, as reflected by CRP and PCT levels (p < 0.05). Conclusion: Inflammation may affect the metabolism of VCZ to VCZ-N-oxide both in adult and elderly patients, and decreased plasma AL levels and increased TBIL levels under inflammatory conditions may also alter VCZ metabolism.

Modified Glasgow prognostic score (mGPS) is correlated with sarcopenia and dominates the prognostic role of baseline body composition parameters in advanced gastric and esophagogastric junction cancer patients undergoing first-line treatment from the phase III EXPAND trial

Sarcopenia represents an established adverse prognostic factor in cancer patients. Consequently, different means to counteract sarcopenia have been proposed to improve cancer treatment. Computed tomography (CT)-based measurements, also labor intensive, are well validated for the analysis of sarcopenia. As inflammation plays a key role in the development of sarcopenia, we here studied the role of the modified Glasgow prognostic score (mGPS), consisting of inflammation parameters plasma C-reactive protein (CRP) and albumin, to predicting sarcopenia and adipose tissue-related body composition (BC) parameters at baseline and their changes during treatment and to analyze its prognostic role in conjunction with BC parameters. CT measurements of BC parameters were carried out at baseline and week 12 in patients with advanced gastric or esophagogastric junction cancer from the phase III EXPAND trial, undergoing first-line platinum-fluoropyrimidine chemotherapy. mGPS was calculated from baseline CRP and albumin plasma levels. Pearson correlation and Cox regression analyses were carried out. mGPS is strongly prognostic for overall survival (OS). Baseline mGPS is significantly correlated with baseline mean muscle attenuation (MA; P < 0.0001). Baseline mGPS did not predict a decline in muscle or adipose tissue parameters during 12 weeks of treatment and a decline in muscle or adipose tissue parameters was not prognostic for OS. MA lost its prognostic role for OS when mGPS or CRP was entered into the Cox models. Eastern Cooperative Oncology Group performance status together with CRP or mGPS remained the sole baseline prognostic factors for OS. Our findings support a model where tumor-mediated inflammatory response represents a strong prognostic factor, which is causally related to sarcopenia, but with no direct causal path from sarcopenia to survival. Therefore, therapeutic targeting of systemic inflammation should be further explored as a promising strategy to improve both sarcopenia and the efficacy and tolerability of cancer treatment.

Perbandingan Efektivitas Terapi Ekstrak Ikan Gabus Dengan Putih Telur Dan Human Albumin 20% Terhadap Peningkatan Kadar Albumin Pasien Hipoalbuminemia Di RSUD dr. Zainoel Abidin

Hypoalbuminemia is a condition where blood albumin levels are less than 3.5 g/dL. In this condition, there will be disruption to the physiological processes in the body. There is a relationship between low albumin levels with an increased risk of infectious complications, a high mortality rate in hospitalized patients, both non-surgical and surgical patients. To restore the important function of albumin, intervention is needed to increase albumin levels in the blood. Human albumin infusion is the most common. However, because of the high price, many other alternatives have been investigated to increase plasma albumin levels. This study aims to determine the effectiveness of snakehead fish extract therapy, compared with egg white and 20% human albumin in increasing albumin levels in hypoalbuminemic patients so that it can save costs and can improve the quality of life of hypoalbuminemia. This research is a quantitative research with Randomized Control Trial design. Samples were collected from August to October 2021 in the surgical inpatient ward of RSUD dr Zainoel Abidin. Data were collected from 36 samples, then divided into 3 treatment groups, namely the egg white group, the snakehead fish extract group and the Human Albumin group. The study used a randomized, blinded clinical trial. The data taken is albumin levels. The data were tested for normality with the Kolmogrov-Sminrnov test, then continued with the ANOVA test. The results obtained 36 samples that meet the inclusion criteria. The average level of increase in the egg white group was -0.0792 (Sig. 0.51), the snakehead fish extract group was 0.1625 (sig. 0.429) and the Human Albumin group was 0.237 (sig. 0.431). From the results of these studies giving snakehead fish extract can be an alternative therapy to treat hypoalbuminemia conditions.Keywords: Hypoalbuminemia, Albumin, Egg white, Snakehead Fish Extract, Human Albumin

Plasma Calcium and Phosphorus Levels and Cardiovascular Disease Risks in Egyptian Type 2 Diabetic Patients

Background: Cardiovascular complication of diabetes is considered an important issue that needs deep investigations. The levels of plasma calcium (Ca) and phosphorus (P) have been implicated as having an association to cardiovascular diseases.&#x0D; AIM: The objective of the present research was to study the plasma levels of both Ca and P and their association to the atherogenic ratio; total cholesterol: high density lipoprotein-cholesterol and the plasma albumin in male and female patients with type 2-diabetes. The interrelation between anthropometric parameters represented by body mass index (BMI), waist circumference and waist/hip ratio with Ca and P were studied. Also, the association between plasma Ca and P with their dietary intake were investigated.&#x0D; Subjects and METODS: Thirty-one type 2-diabetic male and female patients participated in the study, in addition of ten healthy subjects. Biochemical parameters, anthropometric measurements and nutrients′ intake were assessed. Biochemical parameters include plasma Ca, P, lipid profile, albumin, liver function tests and creatinine.&#x0D; RESULTS: Plasma Ca levels of female patients of BMI&gt; 30 kg/m2 demonstrated significant increase compared to the control group. All male and female patients showed significant increase in plasma P compared to the control group. Glycosylated hemoglobin of male and females showed significant high values compared to the control group except for diabetic male of BMI&gt;30 kg/m2 that showed insignificant increase. No significant changes in plasma TG and LDL-C levels were noticed compared to the control. Plasma TC of patients showed significant high levels compared to the control group. The levels of HDL-C of patients were significantly lower than that of the control. The ratios of TC/HDL-C diabetic patients either male or female and whatever their BMI were significantly higher than that of the control. No significant changes in plasma activities of ALT and AST and bilirubin levels were observed among the different groups including the control. Plasma albumin levels demonstrated significant reduction compared to the control group whatever their sexes or BMI. Plasma creatinine levels of the different diabetic groups showed insignificant change from the control group except for the male group of BMI&lt;30 kg/m2 that showed significant elevation. In male, plasma Ca showed significant negative correlation with albumin and positive correlation with creatinine and dietary vitamin D. In female, a significant positive correlation was noticed between plasma and dietary P while a negative correlation was observed between plasma Ca and dietary iron.&#x0D; CONCLUSION: Elevated of plasma P together with reduced plasma albumin and elevated TC/HDL-C may reflect an association of plasma P to CVD in male and female diabetic subjects while high plasma Ca might predict CVD in only female diabetic patients of BMI &gt; 30 kg/m2.

Effect of Double-Channel Anastomosis and Esophagojejunal Anastomosis on Postoperative Recovery and Complications of Laparoscopic D2 Radical Gastrectomy for Gastric Cancer.

The aim of this study was to investigate the effects of double-channel anastomosis versus esophagojejunostomy on postoperative recovery and complications after laparoscopic D2 radical gastrectomy for early proximal gastric cancer. The cases were collected from 100 patients with early proximal gastric cancer admitted to our hospital from January 2017 to January 2021. According to different surgical methods, they were divided into control group (total gastrectomy + esophagojejunal anastomosis) and experimental group (D2 radical resection + double-channel anastomosis). The two groups were compared in terms of clinical outcomes (operative time, intraoperative blood loss, number of lymph nodes dissected, digestive tract anastomosis time, postoperative exhaust, and hospitalization days), postoperative complications, and nutritional status; the expression of T lymphocyte subsets in peripheral blood of the two groups was detected to reflect the recovery of immune ability. There was no significant difference between the observation group and the control group in clinical operation effect indexes (P < 0.05). The incidence of complications of dumping syndrome and reflux esophagitis in the observation group was significantly lower than that in the control group (P < 0.05). In terms of postoperative nutritional status, the ratio of plasma albumin level and body weight restored to operation at 12 and 24 weeks after operation in the observation group was significantly higher than that in the control group (P < 0.05). 3 months after the operation, the levels of CD3 +, CD4 + cell subsets, and CD4+/CD8+ index reflecting the recovery of immune ability in the observation group were significantly higher than those in the observation group (P < 0.05). The application of double-channel anastomosis in laparoscopic D2 radical gastrectomy for early proximal gastric cancer has a better effect on reducing complications and promoting postoperative recovery, which is of great application value.

Is there an association between inflammatory/anti-oxidant markers and the presence of psychotic symptoms or severity of illness in mood and psychotic disorders? A multi-centric study on a drug-free sample

The immune and antioxidant systems are intimately connected and their role in the etiology of major psychiatric disorders is currently under study. The aim of this study was to evaluate the potential associations between inflammatory/antioxidant peripheral markers and presence of psychotic symptoms or severity of illness in patients affected by major psychiatric disorders.One hundred and twenty-six drug-free patients were included. A blood sample was collected to measure total/B/T lymphocytes and plasma levels of albumin, total bilirubin, uric acid, C-reactive protein, and vitamins A and E. Severity of illness was assessed using psychometric scales. Groups of patients divided according to diagnosis were compared in terms of measured markers using multivariate analyses of variance (MANOVAs). Linear and logistic regression analyses were performed to investigate the potential association between markers and severity of illness or presence/absence of psychotic symptoms.Albumin plasma levels were higher in patients with substance-induced psychotic disorder (SIPD) than subjects affected by schizophrenia (F ​= ​4.923; p ​= ​0.003). Lower vitamin E (OR ​= ​0.81; p ​= ​0.014) and T lymphocyte (OR ​= ​0.99; p ​= ​0.048) plasma levels were predictive of lifetime psychotic symptoms. Lower vitamin A levels were associated with higher Montgomery-Åsberg Depression Rating Scale scores (β ​= ​-24.26; p ​= ​0.029), independent of diagnosis.Patients with SIPD may be less vulnerable to oxidative stress. The severity of depressive symptoms, inversely associated with vitamin A plasma levels, is likely to be modulated by the degree of inflammation. Patients presenting with lifetime psychotic symptoms may be more vulnerable to oxidative stress and may have a higher activation of humoral immunity.

Impact of C-reactive protein and albumin levels on short, medium, and long term mortality in patients with diffuse large B-cell lymphoma

Objectives and study design: In this population-based study of 602 patients, we amended C-reactive protein (CRP) and plasma albumin (PA) levels around the diagnosis of diffuse large B-cell lymphoma (DLBCL) to the International Prognostic Index (IPI) and assessed 0–90, 91–365, and +365-day survival. Results: The CRP did not contribute to the IPI's prognostic or discriminatory ability, regardless of time period, particularly not in models with PA. In contrast, the PA was an important contributor, especially in the 0–90 day period, but also up to one year after the diagnosis. For day 0–90, the model with the IPI only had an Area Under the Receiver Operating Characteristics (AUROC) of 0.742, whereas the IPI with PA as a continuous variable rendered an AUROC of 0.841. Especially the lower PA quartile (18–32 g/L) contributed to the worse prognosis. Conclusions: The amendment of PA to the IPI may significantly improve the short-term prognostic and discriminative ability. Key messages The amendment of the plasma albumin (PA) level to the International Prognostic Index significantly improved the prediction of mortality up to one year after the diagnosis of diffuse large B-cell lymphoma. It was especially the lower quartile of the PA level (18–32 g/L) that contributed to the worse prognosis.

Evolution of Quality of Life in Chronic Kidney Disease Stage 4–5 Patients Transitioning to Dialysis and Transplantation

Introduction: Chronic kidney disease (CKD) has a profound effect on patients’ health-related quality of life (QoL). Longitudinal studies on QoL in CKD are scarce and have explored selected patients on renal replacement therapy (RRT). We studied the evolution of QoL in patients with advanced CKD transitioning to dialysis and transplantation in a prospective follow-up study. Methods: A total of 100 participants of the Chronic Arterial Disease, Quality of Life, and Mortality in Chronic Kidney Injury (CADKID) study were enrolled in the study. Kidney Disease Quality of Life Short Form, biochemistry, and echocardiography were obtained at baseline and after a median interval of 33 (range 12–85) months. Results: At the time of the follow-up QoL assessment, 32 patients were not receiving RRT, 30 were on hemodialysis (HD), 19 on peritoneal dialysis (PD), and 19 had received a kidney transplant. Among kidney transplant recipients (KTRs), “Burden of Kidney Disease” and “General Health” domains improved compared to patients who initiated HD (p < 0.0001 and p = 0.007, respectively), PD (p = 0.0005 and p = 0.03, respectively), or remained in predialysis care (p = 0.009 and p = 0.003, respectively) while “Effects of Kidney Disease” improved compared to those who started HD (p = 0.004) or PD (p = 0.002). The change in Short Form-36 (SF-36) Physical Component Summary was not different between patients on different treatment modalities. Higher plasma albumin and cholesterol levels were associated with improved QoL in “Symptoms/Problems” (r = 0.28, p = 0.005, and r = 0.30, p = 0.004, respectively) and “Effects of Kidney Disease” (r = 0.27, p = 0.008, and r = 0.24, p = 0.03, respectively). Conclusion: QoL improved in KTRs in kidney disease-specific domains compared to patients initiating dialysis or those without RRT. Plasma albumin and lipids were associated with QoL over time.

Correlations of MMP-9 and PPARγ gene polymorphisms with occurrence of preeclampsia.

The aim of this study was to investigate the expressions of matrix metalloproteinase-9 (MMP-9) and peroxisome proliferator-activated receptor gamma (PPARγ) in the placenta of patients with preeclampsia and to elucidate the associations of their polymorphisms with the occurrence of preeclampsia. A total of 200 patients with preeclampsia (Preeclampsia group) and 100 pregnant women with normal delivery (Control group) were enrolled as research subjects. The expressions of MMP-9 and PPARγ in placentae of Preeclampsia group and Control group were measured by Western blotting. Conformation-difference gel electrophoresis was adopted for typing single nucleotide polymorphisms (SNPs) rs101201 and rs23102 in the promoter region of MMP-9 gene and rs201018 and rs102934 in the promoter region of PPARγ gene. Chi-square test was conducted to analyze whether the distribution frequency of MMP-9 and PPARγ genotypes was consistent with the law of genetic equilibrium. The correlations of the alleles and polymorphisms of MMP-9 and PPARγ with the occurrence of preeclampsia were analyzed. In addition, the associations of rs101201 genotype GG of MMP-9 gene and rs201018 genotype TT of PPARγ gene with the clinicopathological features of preeclampsia were analyzed. Compared with Control group, the protein expression level of MMP-9 was significantly down-regulated (p<0.05), while the protein expression level of PPARγ was significantly up-regulated in placental tissues of Preeclampsia group (p<0.05). Based on Hardy-Weinberg equilibrium analysis, the two polymorphisms of both MMP-9 and PPARγ were consistent with the genetic equilibrium distribution (p>0.05). Gene correlation analysis showed that rs101201 polymorphism and its alleles in the promoter region of MMP-9 gene and rs201018 polymorphism and its alleles in the promoter region of PPARγ gene were correlated with the occurrence of preeclampsia (p<0.05). Besides, body mass index (BMI) value, gestational age, systolic blood pressure, and serum creatinine level in preeclampsia patients with the genotype GG of rs101201 in the promoter region of MMP-9 gene were not statistically significantly different from those in Control group (p>0.05). Furthermore, no statistically significant differences were observed in gravidity, parity, gestational age, systolic blood pressure, serum creatinine level, and plasma albumin level between preeclampsia patients with the genotype TT of rs201018 in the promoter region of PPARγ gene and those in Control group (p>0.05). PPARγ and MMP-9 are abnormally expressed in the placenta of patients with preeclampsia. Moreover, rs201018 polymorphism in the promoter region of PPARγ gene and rs101201 polymorphism in the promoter region of MMP-9 gene are correlated with the occurrence of preeclampsia.