Serum Inorganic Phosphorus Research Articles

Association of mineral metabolism biomarkers with chronic kidney disease in Chinese adults

BackgroundWe aimed to examine the association of three mineral metabolism markers, including serum calcium, inorganic phosphorus, and intact parathyroid hormone with the risk of chronic kidney disease (CKD) at all stages.MethodsThis retrospective cohort study involved 3563 participants, including 3274 CKD patients and 289 healthy controls. CKD is diagnosed according to clinical guidelines from the 2012 KDIGO. Effect sizes are expressed odds ratio (OR) and 95 confidence interval (CI).ResultsAfter propensity score matching, per 0.5 mg/dL increment of inorganic phosphorus was significantly associated with 1.33-, 1.61-, and 2.85-fold increased risk of CKD at stages 1–2, 4, and 5, respectively. Regarding per 8 pg/mL increment of intact parathyroid hormone, significance was only noted for stage 5. In subsidiary analyses, the risk prediction of mineral metabolism markers under study was more evident in males and hypertensive subjects. A nomogram prediction model was constructed based on age, sex, and three mineral metabolism markers for CKD, with decent accuracy.ConclusionsOur findings indicate that serum calcium was associated with all-stage CKD risk, whereas the association for inorganic phosphorus and intact parathyroid hormone was significant at advanced stages.

ИССЛЕДОВАНИЕ ФИЗИОЛОГО-БИОХИМИЧЕСКИХ ПОКАЗАТЕЛЕЙ СИНГИЛЯ (LIZA AURATA, RISSO) В КАСПИЙСКОМ МОРЕ

The paper outlines the study of the physiological and biochemical parameters 
 of golden mullet (Liza aurata, Risso) in the Caspian Sea. Collecting material was carried out in the western part of the Northern and Middle Caspian in September-October 2019. The female and male species were analyzed. The histomorphological investigation of the gonads of females and males indicated the completion of spawning. The morphological picture of the gonads of golden mullet
 of both sexes corresponded to the maturity scale of this species as applied to the Caspian region. 
 In the blood there was determined the concentration of hemoglobin, total serum protein, total lipids, triglycerides, cholesterol, glucose, and inorganic phosphorus. A valid positive correlation dependence (p < 0.05) of weight and length of females (r = 0.9340) and males (r = 0.9320) was stated. 
 In females high correlations were recorded between the levels of total serum protein and cholesterol (r = 0.9071), total serum protein and hemoglobin (r = 0.9706), glucose and hemoglobin 
 (r = 0.8897) with a statistical significance level of p < 0.05. The revealed statistical dependencies of physiological and biochemical parameters of fish blood indicated their important role in the body in optimizing the total energy costs after spawning. According to the study of males, there has been found a high (r = 0.9195) significant (p < 0.05) correlation relationship between the content 
 of hemoglobin and cholesterol in the blood. The content of total lipids in muscles, gonads and liver of females and males of golden mullet were comparable. The levels of water-soluble protein in the muscles, liver, and gonads of fish of both sexes did not differ significantly. The obtained research results on the complex of physiological and biochemical parameters of golden mullet will significantly increase the volume of reliable information about the physiological status of the organism of the studied species of mullet in the modern ecological conditions of the Caspian Sea.

Evaluation of haemato-biochemical parameters for assessment of fracture healing in dogs

Biochemical parameters like serum calcium, inorganic phosphorus, C-reactive protein and alkaline phosphatase were evaluated during fracture healing in 6 dogs with distal femoral diaphyseal fractures, which were stabilized with String of pearls (SOP) locking plates. Statistical analysis revealed a highly significant difference (P

PREVALENCE AND RISK FACTORS OF SUBCLINICAL MILK FEVER AND KETOSIS IN LACTATING CROSS-BRED DAIRY COWS WITH THEIR THERAPEUTIC MANAGEMENT IN BANGLADESH

Background: Bovine Milk fever (MF/hypocalcaemia) and ketosis (CK/hypoglycemia and hyperketonemia) both in clinical and sub-clinical forms are the most important metabolic diseases caused by metabolic disorders of calcium and carbohydrate respectively that affect mainly high milk yielding dairy cows worldwide. Sub-clinical form may be more costly due to comparatively high prevalence and consequence of high risk of decreased productive and reproductive performances with increased reproductive and other disorders. Objectives: The objectives of this study were to determine the prevalence of sub-clinical hypocalcaemia (SCHC) and sub-clinical ketosis (SCK) and to investigate important potential risk factors for SCHC and SCK with their therapeutic management in lactating cross-bred dairy cows. Materials and Methods: A cross sectional study was conducted on 220 dairy crossbred (HF  L = 190, SH  L = 20 and JS  L = 10) cows maintained in nine dairy farms and one smallholder farm during the period from July to November 2016. The parity (1 to 8), lactation stages (1 to 13 weeks), body condition score (BCS), breed (3 crossbreds), age (3.5 to 14 years) and milk yield (liter/day) were evaluated as possible risk factors. The serum calcium, inorganic phosphorus, magnesium and glucose concentrations of the 220 dairy cows were determined by using imported commercial kits. Dairy cows with serum calcium concentrations  8.0 mg/dl and serum glucose  44.0 mg / dl with positive ketone tests but not showing any clinical signs were considered SCHC and SCK respectively. Results: The overall prevalence of SCHC was 30.0%, of which 32.11% were recorded in HF  L, 15.0% in SH  L and 20.0% in JS  L cross-bred cows. The overall prevalence of SCK was 25.0%, of which 27.37% in HF  L, 10.0% in SH  L and 10.0% in JS  L cross-bred cows. The SCHC was recorded 10 times greater than MF and SCK 6 times greater than CK in Bangladesh. The hypocalcemia and hypophosphatemia with hypermagnesemia status were recorded in SCHC affected lactating cows which were more significantly (p < 0.05) higher (46.67%) at 4th parity and lower (16.67%) at 1st parity. The significantly (p < 0.01) higher prevalence of SCK was recorded at the 4th (53.33%) in comparison to other parity especially lowest at 1st (2.78%) and 2nd (4.0%) parity. The significantly (p < 0.1) highest prevalence of SCHC and SCK were recorded at high milk yield during the 1st (94.44%; 77.78%) and 2nd (66.67%; 56.67%) weeks of lactation period than the higher lactation stages respectively. The effects of BCS on the milk yield and the prevalence of SCHC and SCK are presented and discussed. Encouraging results with increased blood calcium and glucose levels were obtained on the therapeutic response of SCHC with oral calcium and SCK with oral propylene glycol. Conclusions: The SCHC and SCK have detrimental effects on cow health, productivity and reproduction and also predisposes to other diseases and disorders. The efficient balanced ration, periodic screening blood, milk and urine for determination of concerned biochemical constituents and ketone bodies considering risk factors could help to early detection of SCHC and SCK to limit their effects in dairy cattle. The high prevalence of SCHC and SCK recorded in this study should be viewed as a potential health risk to the transition cows that requires further research. Keywords: Sub-clinical milk fever, Sub-clinical ketosis, crossbred cows, prevalence, risk factors, calcium, magnesium, phosphorus, glucose, ketone bodies, therapeutic management, Bangladesh

Osteomalacia and renal failure due to Fanconi syndrome caused by long-term low-dose Adefovir Dipivoxil: a case report

BackgroundProgressive bone pain and fracture and abnormal positron emission tomography combined with a computed tomography are main reasons for the oncologists suspecting bone tumor. During the patient’s medical treatment, the oncologists’ unfamiliarity with adverse reactions to anti-HBV drugs were main reason for the long-term exposure to the drug and the adverse reaction (ADR) experienced by the patient.Case presentationA 63-year-old Chinese man had a 27-month history of progressive generalized bone pain combined with spontaneous fractures. Positron emission tomography combined with a computed tomography, revealed an abnormal increase in ribose metabolism and low positron serum inorganic phosphorus concentration (0.7; 0.78–1.65 mmol/L). Serum creatinine level was 252 μmol/L (53–97) μmol/L, and glomerular filtration rate was 22.79 mL/min/1.73 m2. The patient was referred to a multidisciplinary clinic to clarify the diagnosis of myeloma or bone tumor for further treatment in 2017. His medical history revealed that he had a 30-year history of chronic hepatitis B infection. He had received lamivudine at a daily dose of 100 mg for 19 years (1990 to 2009), which had been changed to adefovir (10 mg/day) owing to lamivudine resistance in 2009. Based on the changes in the patient’s laboratory markers and the results of emission computed tomography and other radiographic findings, adefovir-induced hypophosphatemic osteomalacia due to acquired renal Fanconi syndrome was suspected by the clinical pharmacist. Considerable clinical improvement was observed after adefovir discontinuation and the administration of entecavir (1.0 mg, every other day).ConclusionFanconi syndrome with osteomalacia can develop in patients with chronic hepatitis B infection being treated with adefovir at a conventional low dosage of 10 mg/day. This case highlights the importance of ADR as a differential diagnosis and the need of pharmacists with drug safety expertise expert in the patient management.

P1500SEASONAL VARIATIONS AND VARIATIONS DUE TO OTHER CAUSES IN CLINICAL AND LABORATORY PARAMETERS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims In hemodialysis patients, seasonal variations and changes in dialysis prescription affect laboratory data, blood pressure, and body weight. We examined whether these fluctuations were due to seasonal variations or other causes. Although there are some reports on seasonal changes in hemodialysis patients, there are few reports on observations over multiple years in the same stable patients. Method We studied 65 patients on hemodialysis (36 males and 29 females; average age, 67.7 years; average duration of HD therapy, 13.8 years). The observation period was three years from January 2016 to December 2018; laboratory data and dialysis-related indicators, blood pressure, dry weight, and interdialysis weight gain were examined retrospectively. We excluded cases with dialysis time less than 4 h and patients who were hospitalized during the observation period. Differences in statistical analysis were tested with repeated-measures ANOVA or Friedman test. Results Factors that showed an influence on the laboratory parameters in hemodialysis patients more than twice in the same season in the three-year observation period were serum urea nitrogen (UN), serum creatinine (Cr), serum potassium (K), serum inorganic phosphorus (IP), and serum total bilirubin (T-Bil), serum creatine kinase (CPK), serum glycoalbumin (GA), normalized protein catabolic rate (nPCR), % creatinine production rate (% CGR), systolic blood pressure (sBP), diastolic blood pressure (dBP), and inter-dialytic weight gain (p<0.05). In contrast, the serum albumin concentration (Alb), serum magnesium (Mg), serum parathyroid hormone-INTACT (iPTH), and standardized dialysis amount of urea (KT/Vurea) exhibited gradual changes during the observation period (p<0.05). Conclusion There were indeed seasonal variations with UN, Cr, K, IP, T-Bil, CPK, GA, nPCR, %CGR, sBP, dBP, and inter-dialytic weight gain. However, Alb, Mg, iPTH, KT/Vurea changed owing to dialysis prescription and medicines.

Efficacy and safety of elobixibat in hemodialysis patients with chronic constipation: a retrospective study

BackgroundHemodialysis patients are likely to develop constipation as a complication due to food and fluid restrictions. Elobixibat is a new laxative that inhibits the ileal bile acid transporter expressed in the terminal ileum, suppresses bile acid reabsorption, increases the amount of bile acid flowing into the colon lumen, and promotes water secretion in the colon and colon motility. In this study, we examined the efficacy and safety of elobixibat in maintenance hemodialysis patients with chronic constipation.MethodsIn a study conducted on maintenance hemodialysis patients with chronic constipation, comparisons were conducted retrospectively based on constipation symptoms such as the frequency of spontaneous bowel movements before elobixibat treatment and 12 weeks after the administration of elobixibat, as well as based on blood electrolyte levels.ResultsThe study was conducted on 23 patients, 19 of whom were subjected to treatment efficacy analysis. The frequency of spontaneous bowel movements was 2.0 ± 0.7 times/week before administration of elobixibat and reached 4.9 ± 2.3 times/week after 12 weeks of administration. The increase started after 1 week of treatment. Elobixibat treatment improved the constipation score (baseline, 10.4 ± 3.2; after 12 weeks, 5.7 ± 3.2), the Bristol Stool Form Scale (baseline, 2.2 ± 1.0; after 12 weeks, 4.2 ± 0.7), and patient satisfaction regarding defecation (baseline, 2.9 ± 0.9; after 12 weeks, 1.7 ± 1.1). The interdialytic weight gain (IDWG) was 5.68 ± 0.82% before initiation of treatment and decreased to 4.54 ± 1.34% after 12 weeks. The serum inorganic phosphorus (IP) levels were 5.68 ± 1.25 mg/dL and decreased to 4.93 ± 1.10 mg/dL after 12 weeks.ConclusionsElobixibat was effective in improving constipation symptoms in maintenance hemodialysis patients with chronic constipation. Elobixibat also improved dialysis-related laboratory test results, such as a decrease in serum IP levels and IDWG.Trial registrationUMIN Clinical Trials Registry, UMIN000037285, retrospectively registered

Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism.

ObjectivesThe aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism.MethodsWe studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications.ResultsOf the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (P<0.01) and 8.0±1.0 mg/dL (P<0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism.ConclusionSubtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.

Application effect of extended nursing service in improving malnutrition status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis

Objective To explore the effect of extended nursing service on malnutrition in patients undergoing maintenance hemodialysis combined with peritoneal dialysis. Methods According to the formula, 124 patients with malnutrition in maintenance hemodialysis combined with peritoneal dialysis were divided into intervention group and control group by lottery, 62 in intervention group and 62 in control group. The control group received routine specialist nursing and health education during hospital dialysis, while the intervention group received extended nursing services for 6 months, including telephone follow-up, knowledge lectures and Wechat interaction. The nutritional status of two groups of patients was assessed by modified subjective comprehensive nutrition assessment (MQSGA) one day before the implementation of extended nursing service, three months and six months after the implementation of extended nursing service, and the body mass index(BMI), albumin, prealbumin, hemoglobin, serum calcium and serum phosphorus were measured at the same time. Results There was no significant difference in nutritional status, BMI and blood index between the two groups before intervention (P > 0.05). After 3 months and 6 months of intervention, MQSGA scores of intervention group were (13.28±3.99), (10.17±3.43) respectively, which were significantly lower than those of control group (15.32±3.52), (14.37±3.73). There were significant differences between the two groups (t=2.946, 6.336, P<0.01). After 3 months and 6 months of intervention, BMI was (18.29±2.27), (20.27±2.09) kg/m2, respectively, which were significantly higher than those of control group (16.41±2.32), (16.49±2.26) kg/m2. The difference between the two groups was significant (t=-4.430, -9.372, P <0.01). After 3 months of intervention, albumin, preaalbumin, hemoglobin, serum calcium, and serum inorganic phosphorus in intervention group were (35.63±4.24) g/L, (277.57±29.52) mg/L, (102.03±11.21) g/L,(2.01±0.19) mmol/L, (1.74±0.37) mmol/L; and the control group were (33.19±4.89) g/L, (216.81±24.06) mg/L, (92.58±13.79) g/L, (1.91±0.21) mmol/L, (2.05±0.49) mmol/L, respectively. After 6 months of intervention, the intervention groups were (41.49±6.14) g/L, (344.60±30.56) mg/L, (111.34±10.09) g/L, (2.28±0.18) mmol/L, (1.45±0.33) mmol/L, the control group were (34.16±4.71) g/L, (218.63±24.85) mg/L, (94.36±11.21) g/L, (1.99±0.24) mmol/L, (1.95±0.41) mmol/L. There were significant differences between the two groups (t=-24.484-7.220, P<0.01). Conclusions Extended nursing service can significantly improve the nutritional status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis. Key words: Maintenance hemodialysis combined with peritoneal dialysis; Extended care; Malnutrition; Community care

Clinical and genetic analysis of idiopathic normophosphatemic tumoral calcinosis in 19 patients.

Tumoral calcinosis is a rare clinicopathological entity characterized by ectopic soft-tissue calcification, typically periarticular. Normophosphatemic tumoral calcinosis is seldom reported in East Asian populations, and the preoperative diagnosis is often elusive. This study was performed to characterize the clinical profile of normophosphatemic tumoral calcinosis and investigate the presence of the SAMD9 gene mutation. The clinical features, pathological examination findings, and outcomes of 19 subjects were retrospectively reviewed. All patients were analyzed for SAMD9 gene mutation using paraffin-embedded tumoral calcinosis specimens. Nineteen subjects were analyzed (7 males, 12 females). Their mean age at surgery, mean age at symptom onset, and median disease duration was 51.9 ± 17.3 (range 7-75)years, 49.1 ± 17.2 (range 7-74)years, and 1.3 (interquartile range 0.5-3.0)years, respectively. Lesions were located in the hand in 8 (42.1%) subjects; wrist in 5 (26.3%); shoulder in 2 (10.5%); and hip, knee, buttock, and scrotum in 1 (5.3%) subject each. The lesions in 17 (89.5%) subjects were located around the joints [small joints (hand and wrist) in 13 (68.4%) and large joints (shoulder, hip, and knee) in 4 (21.1%)]. Lesions occurred in the upper limbs in 15 (78.9%) subjects and in the lower limbs in 2 (10.5%). Multiple-lesion involvement (distal right index finger and middle finger) occurred in one (5.3%) subject. Symptoms included pain in 15 (78.9%) subjects, impaired mobility in 5 (26.3%), swelling in 5 (26.3%), numbness in 2 (10.5%), and an asymptomatic mass in 2 (10.5%). The serum inorganic phosphorus concentration was normal in all 19 subjects (mean 1.17 ± 0.15mmol/L). The serum calcium concentration was normal in 18 subjects and low in 1. The serum alkaline phosphatase concentration was normal in all 19 subjects. Pathological examination indicated multiple nodules of calcified materials that manifested an amorphous or granular blue-purple crystal and were surrounded by proliferation of mononuclear or multinuclear macrophages, osteoclastic-like giant cells, fibroblasts, and chronic inflammatory cells. Notably, different phases of pathological manifestations were observed in the same microscopic field. During follow-up (0.5-65.0months), no recurrence of tumoral calcinosis was observed in 18 (94.7%) subjects, but 1 subject developed in situ recurrence of an asymptomatic subcutaneous mass after 6months postoperatively. Genetic analysis in all 19 subjects revealed no SAMD9 gene mutations. Most subjects were females and developed calcinosis in adulthood. Small joints (hand and wrist) and the upper limbs were frequently involved. The presence of different phases of pathological features in the same subject suggests that about half of the study participants had been misdiagnosed with another condition (such as gout, osteoarthritis, etc.). Complete surgical excision led to cure without recurrence during follow-up in majority of the study participants.

Evaluation of nephrotoxicity and ototoxicity of aminosidine (paromomycin)-allopurinol combination in dogs with leishmaniosis due to Leishmania infantum: A randomized, blinded, controlled study

Canine leishmaniosis due to Leishmania infantum is a widespread zoonotic disease. Although aminosidine can be an effective treatment, current therapeutic recommendations do not advocate its use, mainly due to concerns regarding the potential nephrotoxicity and ototoxicity of this drug. The aim of this randomized, blinded, controlled study was to evaluate the nephrotoxicity and ototoxicity of aminosidine-allopurinol combination and compare it with that of meglumine antimonate-allopurinol combination in non-azotemic dogs with leishmaniosis. Forty dogs with leishmaniosis were randomly assigned to be treated with either aminosidine at 15 mg/kg, subcutaneously, once daily for 28 days (group A) or with meglumine antimonate at 100 mg/kg, subcutaneously, once daily for 28 days (group B). In addition to either drug, dogs in both groups were administered allopurinol at 10 mg/kg per os twice daily for 2 months. Kidney function was evaluated through measurement of serum creatinine, urea nitrogen, inorganic phosphorus, and cystatin-c concentrations and complete urinalysis, including protein-to-creatinine ratio, at baseline and after 14, 28, and 60 days from the beginning of the treatment. At the same time points, vestibular and auditory functions were evaluated through neurological examination and brainstem auditory evoked response (BAER) recordings of wave I, wave V, inter-wave I–V latencies, and minimum hearing thresholds. None of the dogs developed clinicopathological evidence of kidney disease during the study. Serum creatinine concentration increased >0.3 mg/dl over baseline in 2 dogs in group A and in 5 dogs in group B. Parameters of kidney function were not significantly different or were improved compared to baseline and the only difference between the two groups was the lower concentration of serum creatinine in group A. None of the dogs developed peripheral vestibular syndrome or hearing impairment. At the end of the study, parameters of auditory function were not significantly different or were improved compared to baseline and there were no differences between the two groups. The results of this study show that the nephrotoxicity and ototoxicity of aminosidine, when administered to non-azotemic dogs with leishmaniosis at 15 mg/kg subcutaneously once daily for 28 days along with allopurinol, is minimal and does not differ from that of meglumine antimonate.

Mineralized tissues in hypophosphatemic rickets.

Hypophosphatemic rickets is caused by renal phosphate wasting that is most commonly due to X-linked dominant mutations in PHEX. PHEX mutations cause hypophosphatemia indirectly, through the increased expression of fibroblast growth factor 23 (FGF23) by osteocytes. FGF23 decreases renal phosphate reabsorption and thereby increases phosphate excretion. The lack of phosphate leads to a mineralization defect at the level of growth plates (rickets), bone tissue (osteomalacia), and teeth, where the defect facilitates the formation of abscesses. The bone tissue immediately adjacent to osteocytes often remains unmineralized ("periosteocytic lesions"), highlighting the osteocyte defect in this disorder. Common clinical features of XLH include deformities of the lower extremities, short stature, enthesopathies, dental abscesses, as well as skull abnormalities such as craniosynostosis and Chiari I malformation. For the past four decades, XLH has been treated by oral phosphate supplementation and calcitriol, which improves rickets and osteomalacia and the dental manifestations, but often does not resolve all aspects of the mineralization defects. A newer treatment approach using inactivating FGF23 antibodies leads to more stable control of serum inorganic phosphorus levels and seems to heal rickets more reliably. However, the long-term benefits of FGF23 antibody treatment remain to be elucidated.

Relationship between the level of estrogen, calcium and phosphorus concentration in serum with benign paroxysmal positional vertigo

Objective:To investigate relationship between the level of estrogen, calcium and phosphorus concentration in serum with benign paroxysmal positional vertigo(BPPV). Method:A total of 84 patients with idiopathic BPPV were enrolled in the experimental group, including 32 non-menopausal women, 24 menopausal women, and 28 males; 83 healthy people without vertigo and vestibular disease were selected as the control group consisted with 32 non-menopausal women, 24 menopausal women and 27 males. The levels of estradiol, serum calcium and serum inorganic phosphorus were measured in all participants. The difference of estrogen level, serum calcium and serum inorganic phosphorus concentration between the experimental group and the control group was analyzed by t test. Result:The total number, age distribution and gender composition of the experimental group and the control group were basically paired, and the age difference was not statistically significant (P=0.71). The overall estrogen level in the experimental group was lower than that in the control group (P<0.01). Among them, the female group's estrogen level, menopausal female estrogen level and male estrogen level in the experimental group were lower than the control group (P<0.01); there was no significant difference in serum calcium and serum inorganic phosphorus concentration between the experimental group and the control group (P=0.55, 0.11, respectively). Conclusion:The decrease of estrogen level may be a risk factor for idiopathic BPPV. The relationship between serum calcium and serum inorganic phosphorus concentration and BPPV needs further study.

Hypotensive episodes on program hemodialysis during dialysis procedure: modern approach for diagnostics, prophylaxis and correction

The study objective is to evaluate the effectiveness of different approaches to correction and prevention of arterial hypotension episodes in patients undergoing long-term hemodialysis (HD). Materials and methods. The study included 35patients undergoing long-term hemodialysis in the dialysis center. In all patients, automatic non-invasive measurement of arterial pressure (AP) was performed using a built-in option of the “artificial kidney” device. Prior to the study, all patients underwent clinical test with evaluation of “dry weight” and bioelectrical impedance analysis. Crossover design was used in the study: at the beginning, hypotensive episodes were corrected in all patients using the standard method (the first 4 hemodialysis procedures); then during the following 4 procedures in addition to standard methods a computer algorithm automatically controlling ultrafiltration rate using an automatic system of pressure control (ASPC) with constant AP monitoring (AP was measured prior to hemodialysis and after it and at least 1 time in the first 5 min of the procedure; from the 4h procedure onwards, intervals were determined by the algorithm automatically) was used. Values of mean AP during hemodialysis procedures for the whole monitoring period were analyzed. The duration of the study was 3 weeks for all patients. Results . Mean pre-dialysis systolic and diastolic AP in the patients for the standard approach was 124.6 ± 27.7 and 74.5 ± 21.1 mm Hg, post-dialysis AP was 114.4 ± 24.4 and 71.3 ± 16.3 mm Hg, respectively. For ASPC, pre-dialysis and post-dialysis AP was statistically significantly higher than for the standard approach: 133.2 ± 21.3 and 79.3 ± 15.8 mm Hg (p &lt;0.001; p = 0.009), 125.7 ± 23.9 and 75.9 ± 18.3 mm Hg (p &lt;0.001; p &lt;0.001). Detailed analysis of intra-dialysis AP measured during the standard approach showed that it was 110.2 ± 17.3 and 68.3 ± 13.9 mm Hg. Using ASPC, intra-dialysis AP was significantly higher: 124 ± 20.5 and 75.9 ± 14.2 mm Hg (p = 0.03; p = 0.02). Mean AP was also higher: 82.5 ± 13.9 mm Hgfor the standard approach versus 91.5 ± 15.6 mm Hg (p = 0.01) for ASPC. The ultrafiltration rates were slightly higher without ASPC (8.2 ml/kg/hour vs. 7.9 ml/kg/hour). Therefore, it was shown that the use of ASPC in addition to standard methods of hypotension correction is effective and safe. There weren»t any significant differences in «hemodialysis-dose effectiveness» (Kt/V) in both groups; however, in the ASPC group target values of inorganic phosphorus in serum (for a dialysis patient) were reached which is one of the most important parameters of hemodialysis adequacy. Concentration of inorganic phosphorus for the ultrafiltration control algorithm was 1.5 mmol/l, for the standard dialysis program — 1.8 mmol/l which shows benefits of ASPC. This data didn»t reach statistical significance (p = 0.07) which likely can be attributed to a low number of observations. Conclusion . Intra-dialysis hypotension with high ultrafiltration rates is a frequent and potentially dangerous complication of hemodialysis which negatively affects patients» long-term prognosis mainly due to an increase in cardiovascular morbidity and mortality. A new method for prevention and correction of hypotension using ASPC allows to decrease ultrafiltration rate on time preventing a hypotensive episode, decreasing its rates and improving attainment of AP target values (both pre- and post-dialysis) as well as intra-dialysis variation during dialysis procedure.

Determination of blood serum calcium, inorganic phoshorus and magnesium in different productive stages of holstein dairy cows

Introduction. The aim of this study was to determine and compare levels of blood serum calcium, inorganic phosphorus and magnesium in the peripartal period and during mid lactation in Holstein dairy cattle. Materials and Methods. Blood samples were collected from 12 cows in late pregnancy, 12 early lactation cows, and 12 mid lactation cows. Results and Conclusions. Serum calcium and inorganic phosphorus in blood of dairy cows in early and mid lactation were significantly lower compared to the values in the blood serum of dairy cows in late pregnancy, probably indicating the increased use of these macro elements by the mammary gland at the early stages of lactation. When the cows were in the lactation period, blood serum magnesium levels were significantly lower compared to the values of dairy cows during late pregnancy, probably indicating the increased use of magnesium by the dairy cows during lactation. The results show that the homeostasis of the macro elements examined in the blood of transition and mid lactation dairy cows was maintained, suggesting their adequate supply from alimentary sources.

Effect of Different Ecbolic Therapy on Serum Macro-Micro Minerals Profile in Dystocia Affected Dangi Cows

The study was conducted in eighteen dystocia affected Dangi cows that were handled without any complications from various villages of Dangs district in South Gujarat to evaluate the effect of different ecbolic therapies on serum macro-micro minerals profile. The cows were divided in to three groups consisting six cows in each. Group-I (T1) and II (T2) cows were given methylergometrine (Nexbolic, 5 mg) and dinoprost tromethamine (Lutalyse, 25 mg) i/m, respectively, soon after parturition. The cows in Group-III (T3) received herbal ecbolic (Exapar, 2-4 boluses, b.i.d.) for first 10 days postpartum. The jugular blood samples were collected aseptically on day 0 (day of calving), 7th, 14th 21st and 28th day postpartum to harvest serum. The serum macro-minerals (calcium, inorganic phosphorus, magnesium) and micro-minerals (copper, cobalt, zinc, iron, manganese) were analyzed using commercially available kits. The mean serum calcium level of Dangi cows did not differ significantly (p&gt;0.05) between T1, T2 and T3. The serum calcium levels showed increasing trend from day 0 to 28th day postpartum and significantly higher (p less than 0.05) calcium levels were observed on 28th day postpartum. The serum inorganic phosphorus and magnesium levels did not differ significantly (p&gt;0.05) at 0 day, 7th, 14th, 21st and 28th day postpartum within and between all the treatment groups including overall mean at different time intervals. The mean copper, cobalt, zinc, iron and manganese concentrations in treatment T1, T2 and T3 groups did not differ significantly (p&gt;0.05) at different time intervals among all the treatment groups.

Hematobiochemical and Urological Alterations in Buffaloes with Post parturient Haemoglobinuria

This study was carried out to estimate the haematological, serum biochemical and urological alterations associated with post parturient haemoglobinuria (PPH) on 70 haemoglobinuria and 30 apparently healthy buffaloes. Blood, serum and urine samples were collected and tested for various haematological, biochemical and urological parameters. Significant decrease in total erythrocyte count, Hb concentration, PCV %, lymphocyte%, serum inorganic phosphorus, total protein, albumin, glucose whereas significant increase in neutrophils%, serum urea, creatinine, total bilirubin and alkaline phosphatase. In PPH colour of urine in haemoglobinuria buffaloes ranged from red, dark red to coffee colour. Analysis of urine samples by Reagent urine strips showed positive for haemoglobin and protein. It was concluded that post parturient haemoglobinuria causes severe alterations in hematobiochemical and urological parameters in buffaloes.

Oxidative Stress and Antioxidant Activity in Buffaloes with Postparturient Hemoglobinuria

The study aims to assess the relation between oxidative stress, antioxidant activity and postparturient hemoglobinuria on70 hemoglobinuria and 30 apparently healthy buffaloes. Blood and serum sampleswere collected and tested for various parameters of oxidative stress and antioxidant enzymes. Significant increase in erythrocytic MDA (malondialdehyde) whereas significant decrease in serum inorganic phosphorus, copper (Cu), selenium (Se),erythrocytic SOD (superoxide dismutase), GPX (glutathione peroxidase) and G6PD (glucose-6-phosphate dehydrogenase). According to these results, there was increase in oxidative stress indicator while antioxidant enzymes activities dramatically decreased in postparturient hemoglobinuria (PPH) affected buffaloes. It was concluded that there is relation between oxidative stress, antioxidant activity and PPH in buffaloes.

Preventive Effects of Vitamin D on Seasonal Influenza A in Infants: A Multicenter, Randomized, Open, Controlled Clinical Trial.

This study aimed to evaluate the clinical efficacy and safety of vitamin D for preventing influenza A in 400 infants in a multicenter, randomized, open, controlled clinical trial. The infants were randomized into low-dose and high-dose vitamin D groups, and serum calcium, inorganic phosphorus and 25-hydroxyvitamin D levels were detected thrice in 4 months. Infants infected with influenza A were monitored for symptoms including fever, cough and wheezing. Pathogen levels and safety of vitamin D treatment were also evaluated. Of 121 cases in total, 78 and 43 cases of influenza A infection occurred in the low-dose and high-dose vitamin D groups, respectively. There was a significant difference between the groups (χ = 14.6324, P = 0.0001). Among the cases of influenza infection, the median durations for fever, cough and wheezing were shorter in the high-dose vitamin D group than in the low-dose vitamin D group. The viral loads showed a downward trend in both groups and were significantly different between the groups at the second and third detections. Additionally, the incidences of adverse events and severe adverse events were very low and not significantly different between the 2 groups. High-dose vitamin D (1200 IU) is suitable for the prevention of seasonal influenza as evidenced by rapid relief from symptoms, rapid decrease in viral loads and disease recovery. In addition, high-dose vitamin D is probably safe for infants.

The Clinical Features of Cystic Parathyroid Adenoma in Chinese Population: A Single-Center Experience.

Objective Cystic parathyroid adenoma is a rare cause of primary hyperparathyroidism, but its preoperative diagnosis and management remain inconclusive. Method We retrospectively identified patients with cystic parathyroid adenomas who underwent surgery at Peking Union Medical College Hospital. Results Patients with cystic parathyroid adenomas had higher serum intact parathyroid hormone and calcium levels, larger maximum tumor diameter, and lower serum inorganic phosphorus level than did those with solid adenomas. Patients with cystic adenomas were predominantly male, and hypercalcemic crisis and atypical adenomas were common. The accuracy of preoperative localization methodologies was lower in patients with cystic adenomas than in patients with solid adenomas. US-guided fine-needle aspiration was performed in 11 patients. In all patients, the iPTH level in cystic fluid was much higher than that in serum. No sign of recurrence was observed after a median follow-up of 39 months. Conclusions Cystic parathyroid adenomas may not be as rare as previously reported. FNA may be a safe and feasible localization methodology for patients with inconclusive preoperative localization methodologies. Close follow-up is necessary for patients with cystic parathyroid adenomas, which account for a substantial proportion of atypical adenoma cases.