Ca Supplementation Research Articles

Nitrogen, Calcium, and Magnesium Inconsistently Affect Tree Growth, Fruit Yield, and Juice Quality of Huanglongbing-affected Orange Trees

The bacterial disease Huanglongbing (HLB) has drastically reduced citrus production in Florida. Nutrients play an important role in plant defense mechanisms and new approaches to manage the disease with balanced nutrition are emerging. Nutrients like nitrogen (N), calcium (Ca), and magnesium (Mg) could extend the productive life of affected trees, although interactions among these nutrients in HLB-affected citrus trees are still unclear. A 2-year study was established in Florida to determine the response of HLB-affected trees to applications of N, Ca, and Mg. The study was conducted with ‘Valencia’ trees (Citrus sinensis L. Osbeck) on Swingle citrumelo (Citrus paradisi Macf. × Poncirus trifoliata L. Raf.) rootstock on a Candler sand. Applications of N at 168, 224 (recommended rate), and 280 kg⋅ha−1 N were used as the main plots. Split-plots consisted of a grower standard treatment receiving only basal Ca (51 kg⋅ha−1) and Mg (56 kg⋅ha−1); supplemental Ca (total Ca inputs: 96 kg⋅ha−1) only; supplemental Mg (total Mg inputs: 101 kg⋅ha−1) only; and supplemental Ca (total Ca inputs: 73.5 kg⋅ha−1) and Mg (total Mg inputs: 78.5 kg⋅ha−1). The following variables were measured: tree size, fruit yield, and juice quality. Although some differences in tree growth among treatments were statistically significant (e.g., greater canopy volume with Mg fertilization at 168 kg⋅ha−1 N), there was no clear and consistent effect of plant nutrition on these variables. Fruit yield was higher with Ca and Mg relative to the grower standard at the lowest N rate in 2020, and there were no other statistically significant differences among treatments. Juice acidity was significantly higher with Mg fertilization relative to other treatments in 2019. As N rates had no significant effect in this study, unlike secondary macronutrients, N rates could potentially be reduced to 168 kg N⋅ha−1 in HLB-affected citrus without affecting vegetative growth, fruit yield, and juice quality. However, this will require optimizing the supply of secondary macronutrients and all other nutrients to develop a balanced nutritional program. Ultimately, the effects of N, Ca, and Mg obtained in this 2-year study should be confirmed with longer-term studies conducted at multiple sites.

A study of Vitamin D supplementation to patients with chronic diseases admitted to Ain Shams University Hospital

Abstract Background Vitamin D deficiency and insufficiency have become a common problem worldwide. Vitamin D has been associated with all causes of mortality in chronic diseases and associated with a longer hospital stay and poor outcome. Aim of the Study to evaluate the role of vitamin D supplementation on the outcome of hospitalization for patients with CLD or CHF admitted to Ain Shams University Hospitals (ASUH) with acute deterioration of their illness. Subjects and methods We conducted prospective case control on 80 patients collected from inpatient ward of endocrinology, divided into 2 groups; 40 patients with chronic liver diseases and 40 patients with heart failure. Serum 25OH-vitamin D and calcium, phosphate and PTH were measured to all participants before intervention. 20 patients of each group (Intervention group) received single dose of vitamin D within 3 days of admission and the other 20 patients of each group (control group) did not receive vitamin D vitamin D. Results no significant difference between patients who received vitamin D supplementation and who did not receive vitamin D supplementation as regards outcome and survival with P value 1.000 in patients with CLD and 0.823 in patients with CHF. On the other hand, we found baseline vitamin D level was an independent predictor of mortality (P value .018). Conclusion We found that a beneficial effect of vitamin D supplementation can't be achieved with single dose vitamin D (200,000 IU) on CHF or CLD hospitalized patients’ mortality. We recommend that vitamin D supplementation should be considered in CLD and CHF outpatients, with exception of hypercalcemic and hyperphosphatemic patients, as baseline vitamin D status affects the disease course and mortality prior to disease deterioration and hospitalization.

Effect of calcium enrichment on the composition, conformation, and functional properties of soy protein

Plant-based diets with sufficient calcium (Ca) supplements are needed to protect the body from Ca deficiencies. The Ca enrichment of protein ingredients during fractionation can provide a new route to increase the Ca content in plant-based products. We, therefore, investigated if the partial replacement of NaOH by Ca(OH)2 during the neutralization step of the fractionation process affects the functional properties of the protein-rich fractions. The protein and oil content of the obtained soy protein-rich fractions (SPFs) were not affected by the use of Ca(OH)2. Moreover, when the Ca content in the SPF was lower than a certain threshold value (6.5 mg Ca/g protein), the functional properties and conformation of SPF did not change significantly. Higher Ca content in the SPF, however, led to protein-rich fractions with larger particle size, higher thermal stability, lower NSI and WHCP values, and weaker gel networks. Thus, any addition of Ca higher than a certain threshold changes the properties of the proteins significantly, which can alter the applicability of the fractions in plant-based food products. Nonetheless, this study showed that with partial replacement of NaOH by Ca(OH)2, the enrichment of SPF with Ca is possible without strongly influencing the SPF properties.

Effects on egg production and quality of supplementing drinking water with calcium and magnesium

This study was conducted to appraise the effects on egg quality and production performance of laying hens when drinking water was supplemented with calcium (Ca) and magnesium (Mg). A total of 384 (64-week-old) Hy-line Brown laying hens were assigned at random to four treatments, which consisted of CON: unsupplemented drinking water; T1: drinking water + 2 mg/L Ca + 250 mg/L Mg; T2: drinking water + 4 mg/L Ca + 510 mg/L Mg /10 L; and T3: drinking water + 5 mg/L Ca and 760 mg/L Mg. The experiment lasted six weeks. Water intake increased linearly in week 1 with the rising levels of Ca and Mg in the drinking water. Increasing the Ca and Mg levels improved eggshell strength (week 2 (P =0.01), week 5 (P =0.01), and week 6 (P = 0.03), and eggshell thickness (week 6) (P =0.02) and reduced the rate at which eggs were broken (week 4) (P =0.01). The supplemental Ca and Mg did not affect egg production, egg weight, Haugh unit, albumen height, eggshell colour, and yolk colour compared with CON. Nor did they influence the Haugh unit and albumen height after storing for 1, 5, 10 and 15 days. In conclusion, adding Ca and Mg to the drinking water increased the thickness and strength of the eggshells.

Assessment of seminal calcium and magnesium levels in infertile men with varicocele before and after varicocelectomy.

Trace elements perform a vital role in all stages of human physiology, as well as reproduction. This study aimed to assess seminal calcium (Ca) and magnesium (Mg) in infertile men associated with varicocele (Vx). Overall, 50 men were divided into two groups: fertile men (n=20) and infertile men who were scheduled for Vx surgical repair (n=30). Exclusion criteria were as follows: azoospermia, smoking, leukocytospermia, and consumption of Ca and/or Mg supplements. All cases were subjected to history taking and clinical examination. Semen analysis and assessment of seminal Ca and Mg by the colorimetric method were carried out for all cases at the base point and 3 months postvaricocelectomy. Generally, the mean seminal Ca and Mg levels demonstrated significant decreases in infertile men with Vx compared with the healthy fertile men linked to higher Vx grade as well as Vx bilaterality. These seminal decreases demonstrated significant increases after Vx surgical repair. Collectively, seminal Ca and Mg levels showed a significant positive correlation (r=0.665, p=0.001). Besides, seminal Ca, Mg levels, and Ca/Mg ratio showed significant positive correlation with sperm concentration (r=0.479, p=0.001; r=0.541, p=0.001; r=0.282, p=0.001, respectively), sperm motility percentage (r=0.493, p=0.001; r=0.477, p=0.001; r=0.353, P=0.001, respectively), and sperm normal forms percentage (r=0.578, p=0.001; r=0.520, p=0.001; r=0.430, p=0.001, respectively). Seminal Ca and Mg levels and Ca/Mg ratio are significantly decreased in infertile men associated with Vx compared with fertile men with significant increases after varicocelectomy.

Supplemental calcium improves freezing tolerance of spinach (Spinacia oleracea L.) by mitigating membrane and photosynthetic damage, and bolstering anti-oxidant and cell-wall status

Supplemental calcium (Ca2+) fertilization has been reported to enhance plant tolerance against various abiotic stresses, however, its effect on freezing tolerance has not been well studied. We investigated the effect of Ca2+ supplementation on freezing tolerance of spinach (Spinacia oleracea L.) at whole-plant as well as excised-leaf level. Seedlings supplemented with 20 and 25 mM Ca2+ through sub-irrigation efficiently assimilated Ca2+, evident by higher leaf-Ca2+content. Supplemental Ca2+ did not impede leaf-growth (leaf-area) but slightly increased dry weight/fresh weight ratio compared to the control. Supplemental Ca2+ significantly improved freezing tolerance as evident by reducing K+/Mg2+/total ion-leakage (i.e. indicative of less membrane damage), alleviating oxidative stress (less accumulation of O2 and H2O2), and enhancing PSII potential quantum yield /energy trapping efficiency (Fv/Fm) following a relatively moderate or severe freeze-thaw stress, i.e. −5.5 and −6.5 ˚C. Improved freezing tolerance by Ca2+ supplementation was paralleled by enhanced activities of antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT), and ascorbate peroxidase (APX). Our data further suggests that, besides a bolstered antioxidant status, improved freezing tolerance of Ca2+-fed seedlings may also be associated with reduced loss of Ca2+ from plasma membrane (due to lower abundance of leaked K+ in extracellular spaces) as well as due to increased mechanical strength of cell wall as evident by cell wall augmentation.

Calcium Intake Is Inversely Related to Risk of Obesity among American Young Adults over a 30-Year Follow-Up.

Calcium (Ca) is an essential nutrient that may play an important role in weight maintenance through its involvement in energy or lipid metabolism. However, little is known about the long-term associations of Ca intake with obesity risk. We aimed to prospectively examine the association between cumulative Ca intake and the incidence of obesity among American young adults over 30 y of follow-up. Participants were from the CARDIA (Coronary Artery Risk Development in Young Adults) study. A total of 4097 of 5115 black and white individuals aged 18-30 y at baseline in 1985-1986 were included in the current analysis. Dietary and supplemental Ca intake was assessed by the validated interview-based CARDIA diet history at baseline and exam years 7 and 20. Incident cases of obesity were identified when BMI was ≥30kg/m2 for the first time since baseline. A survival analysis was performed using Cox proportional hazards regression models to estimate the HRs and corresponding 95% CIs for obesity incidence during follow-up. During a 30-y follow-up (mean±SD: 20± 10 y), 1675 participants developed obesity. Cumulative total Ca intake (dietary plus supplemental Ca) was inversely associated with incidence of obesity in multivariable-adjusted analysis [quintile (Q)5 (highest intake) compared with Q1 (lowest intake): HR: 0.68; 95% CI: 0.56, 0.82; P-trend <0.01]. This inverse association persisted among Ca supplement users (Q5 compared with Q1: HR: 0.53; 95% CI: 0.40, 0.70; P-trend <0.01), but was not seen among nonusers. Following a cohort of Americans from young adulthood to midlife, an inverse association between calcium intake and obesity incidence was observed. Further studies are needed to confirm our findings.

Denosumab Induced Severe Hypocalcemia in a Patient With Metastatic Prostate Cancer

Background: Denosumab can lead to severe hypocalcemia in patients with underlying risk factors such as vitamin D deficiency, low PTH, hypomagnesemia, and CKD. Denosumab is a monoclonal antibody against RANKL, reducing the activity of osteoclasts and thus reducing the release of calcium in the bloodstream causing hypocalcemia. Hypocalcemia can range from mild to severe symptoms requiring prolonged hospitalization. Medications such as zoledronic acid and Denosumab are known to reduce the occurrence of Skeletal related events (pathological fracture, spinal cord compression, and radiation to bone). For metastatic prostate cancer, about 90% can develop bone metastasis with significant morbidity and mortality [1]. Our patient presented with severe hypocalcemia after denosumab use without any above risk factors. Clinical Case: A 66-year-old male with a medical history of Prostate cancer with Metastasis to chest and bone presented to ER with syncope. Patient-reported poor oral intake, nausea, and vomiting for the last few days. In the ER, the patient was found afebrile, bp 116/76, HR 92, saturating 100% on room air. On examination, the patient was found lethargic, malnourished, foley in place due to chronic urinary retention. The abdomen was soft and non-tender. Laboratory findings were significant for Hb 9.1, Na 133, K3.6, bicarb 21, total calcium (Ca) 4.2, ionized Ca 0.63 and corrected Ca 5.4, magnesium 1.6, phosphorus 2.1, albumin 3.3, ALT 218, AST 229, ALP 1607. Lipase 82, Total bilirubin 1.5, direct bilirubin 0.8. Spot Urinary Ca 0.7, Vitamin D 25 OH 36.9, serum PTH 225 pg/mL. Serum cortisol AM 20.9, BUN 16, and serum Creatinine 1.0. The patient was started on 11g calcium gluconate in 1L dextrose @ 50c/hr and calcitriol 0.25mcg twice daily. Serum Ca level was monitored every 6 hours and reached 6.7. Later was started on Ca carbonate 1250 TID with meals. Finally, after electrolyte correction, the patient clinically improved and was discharged with the plan to follow Calcium at the outpatient clinic. On review of previous labs at the oncology clinic, the patient received Denosumab at his oncologist’s clinic 10 days before this hospital admission, last Ca level from 6 months ago 8.6, the patient was not any vitamin D or Ca supplement. Conclusion: Many case reports have been published on severe hypocalcemia after denosumab usage. Several patients had underlying risk factors such as vitamin D deficiency, osteoblastic lesion, and AKI leading to an additional cause of hypocalcemia. We emphasize careful monitoring of serum Ca levels particularly in the first few weeks of treatment even without significant risk factors for hypocalcemia.

Novel Heterozygous Calcium Sensing Receptor (CASR) Genetic Variant in Child with Unique Phenotype: Hypocalcemia, Mandibular Hypoplasia, Renal Cysts and Type E Brachydactyly

Background: There are over 230 disease-causing variants in the calcium-sensing receptor gene (CaSR). Gain-of-function missense mutations in CaSR cause Autosomal Dominant Hypocalcemia (ADH) characterized by hypocalcemia (hCa), hypoparathyroidism (hPTH), and hypercalciuria. Patients with ADH are sensitive to fluctuations in serum calcium (Ca); and supplementation with Ca and vitamin D can cause inappropriate renal calcium retention leading to hypercalcemic events and long-term renal complications. Clinical Case: A 15-year-old adopted (at age 18 months) Korean female was initially diagnosed with hPTH and chronic hCa after presenting with hCa seizures. Laboratory values showed hCa (7.7 mg/dL), hyperphosphatemia (7.6 mg/dL) and hPTH (< 3 pg/mL.) Initially, she was treated with Ca supplementation (20 mg/kg/day elemental Ca), and calcitriol (0.01 mcg/kg/day). She presented at age 4 with hematuria and was found to have obstructive nephrolithiasis requiring operative intervention. Renal ultrasound (US) showed bilateral medullary nephrocalcinosis. She continued treatment with Ca and calcitriol. At age 6, a thiazide diuretic and potassium citrate supplement were added due to hypercalciuria. She had recurrent nephrolithiasis and persistent nephrocalcinosis. Follow-up renal US also showed bilateral renal cysts. Biweekly laboratory evaluation demonstrated an exuberant response to calcium supplementation. Serum Ca levels oscillated between 7.0 -10 mg/dL, but she showed minimal symptoms of hCa. At age 14, she was also recognized to have submandibular hypoplasia and brachydactyly of the 4th and 5th metacarpals and metatarsals bilaterally and genetic testing for CaSR gene mutation was requested. Sshe developed acute kidney injury and hypercalcemia, possibly precipitated by viral illness. However, 3 weeks before, calcitriol dose was increased to 1.25 mcg twice a day (0.07 mcg/kg/day). At admission, serum Ca was 12.7 mg/dL, iPTH 5.2 mg/dL, phosphorus 4.5 mg/dL, BUN 36 mg/dL, creatinine 1.85 mg/dL. Symptoms included headache, muscle spasm and throat spasm. She received intravenous fluids and recovered, but had an extended hospital stay. Targeted genetic analysis of the CaSR gene was completed, and identified a heterozygous variant (c.2506G>T, p.V836L) which is predicted to be likely pathogenic and cause ADH. After CaSR gene mutation identification, the calcitriol and also elemental Ca dosing were decreased to achieve a low Ca level (~7 mg/dL) with normal urine Ca/creatinine ratio. Patient remains asymptomatic. Conclusion: This is the first case of a novel mutation in the CaSR (c.2506G>T, p.V836L) associated with ADH, brachydactyly, renal cysts, and mandibular hypoplasia. Timely genetic testing for ADH in patients with newly diagnosed hPTH can lead to changes in therapy and improved prognosis.

TransCon PTH as a Hormone Replacement Therapy for Patients with Hypoparathyroidism: 6-Month Update from the PaTH Forward Open-Label Extension

Background: Hypoparathyroidism (HP) is characterized by insufficient levels of parathyroid hormone (PTH), resulting in hypocalcemia, hyperphosphatemia, hypercalciuria, and a reduced quality of life (QoL). PTH replacement therapy should restore physiologic levels of PTH and restore downstream physiologic levels of calcitriol, promoting independence from Ca and active vitamin D supplements and normalization of QoL.TransCon PTH is an investigational long-acting prodrug of PTH(1–34) for the treatment of HP. During the initial 4-week fixed-dose period of the PaTH Forward Trial, TransCon PTH enabled 82% of subjects to achieve independence from standard of care (SoC; no active vitamin D and Ca ≤ 500 mg/day) compared to 15% with placebo. Here, we report 6-month (Week 26) results from the open-label extension (OLE). Methods: PaTH Forward is a phase 2, double-blind, placebo-controlled trial evaluating TransCon PTH in adult HP patients treated with SoC. Subjects received fixed doses of TransCon PTH 15, 18, or 21 µg PTH(1–34)/day or placebo for 4 weeks, followed by an OLE period during which TransCon PTH dose was titrated (6–30 µg PTH[1–34]/day) per individual dosing requirement. Safety and efficacy endpoints were evaluated at predefined timepoints over the OLE. Endpoints were evaluated at Week 26 including 1) sCa, 2) 24-hour uCa, 3) independence from active vitamin D, and 4) independence from therapeutics doses of oral calcium. QoL was assessed by the SF-36 and the Hypoparathyroidism Patient Experience Scales (HPES). Results: All 59 subjects completed the initial 4-week period and continued in the OLE; 58 subjects continue in the OLE beyond 6 months (1 withdrew unrelated to safety or efficacy). TransCon PTH enabled independence from SoC (no active vitamin D and Ca ≤ 500 mg/day) in 91% of subjects and independence from all supplements (no active vitamin D and no Ca) in 76% of subjects by Week 26. Mean 24-hour uCa decreased from a baseline mean of 415 mg/24h to 178 mg/24h by Week 26 (n = 44) while maintaining sCa, and reducing sP and CaxP to fall within the normal range. The mean scores for all SF-36 summary and domains increased from below normal at baseline to within the normal range by Week 26. The HPES Symptom and Impact scores continuously improved through 26 weeks for TransCon PTH and placebo subjects switching to TransCon PTH. TransCon PTH continued to be well-tolerated with no treatment-related serious or severe adverse events. Conclusions: Results from the OLE of the PaTH Forward Trial demonstrated that TransCon PTH continued to enable independence from active vitamin D and Ca supplements for most subjects while maintaining normal sCa, sP, uCa, and demonstrating enhanced quality of life, supporting its potential as a hormone replacement therapy for patients with HP. TransCon PTH will be further evaluated in the phase 3 PaTHway Trial.

Effect of oral calcium administration on metabolic status and uterine health of dairy cows with reduced postpartum rumination and eating time

BackgroundHypocalcemia has detrimental effects on health and performance of dairy cows. As hypocalcemic cows show reduced feed intake, we hypothesized that cows with reduced combined rumination and eating time (CRET) may benefit from Ca supplementation. The objective was to evaluate the effect of postpartum oral Ca administration on metabolic status (Calcium [Ca], fatty acids [FA], and β-Hydroxybutyrate [BHB] serum concentrations) and incidence of puerperal metritis (PM) in dairy cows with reduced postpartum CRET. Cows in an organic-certified dairy, diagnosed with reduced CRET (< 489 min/d; n = 88) during the first day postpartum were assigned into 1 of 2 treatments: i) Calcium administration (CA; n = 45) that received 1 Ca oral capsule (Bovikalc bolus, Boehringer Ingelheim, St. Joseph, MO) containing CaCl2 and CaSO4 (43 g of Ca) once per day, for 3 consecutive days, starting at d 1 postpartum; and ii) Control (CON; n = 43) that did not receive oral Ca. A convenience group consisting of cows with CRET ≥489 min/d was used for comparison and did not receive oral Ca (NOR; n = 96).ResultsAt day 1 postpartum cows with reduced CRET had lower Ca serum concentrations (CA = 2.08 mmol/L; CON = 2.06 mmol/L) compared with NOR cows (2.17 mmol/L). Calcium concentrations at d 3, 5, and 12 postpartum were not different among the three groups. Serum FA concentrations at d 1, 3 and 5 postpartum were higher in both CA and CON cows compared with NOR. At d 12, only CA cows had higher FA concentrations than NOR cows. Serum BHB concentrations at d 3 were highest in CA, with no difference between CON and NOR. At d 5, BHB concentrations were higher in CA, followed by CON, and NOR. No effect was observed for Ca administration on incidence of PM and reproductive performance. CON cows had lower survival at 30 DIM (86.5%) than NOR cows (97.9%).ConclusionsThe use of remote sensor technology identified cows with reduced rumination and eating time that had lower postpartum serum concentrations of calcium and altered metabolic status. However, oral calcium administration to cows with reduced CRET did not affect incidence of metabolic disorders nor reproductive health and subsequent pregnancy. Although survival at 30 days postpartum was lower for non-Ca supplemented cows, the identification of effective interventions in cows with reduced CRET requires further consideration.

Change of Physiological Properties and Ion Distribution by Synergistic Effect of Ca2+ and Grafting under Salt Stress on Cucumber Seedlings

Salinization is an important soil environmental problem, which severely restricts the sustainable production of cucumbers. Therefore, how to improve the salt tolerance of cucumbers is a global problem. Grafting improves the resistance of crops, and calcium ion (Ca2+) weakens the permeability of the plasma membrane. In this paper, grafting cucumber with NaCl-free treatment was the control treatment (CK). Under salt stress, grafting combined different concentrations of CaCl2 and non-grafted (NG) were considered as treatments. The synergistic effect of grafting and Ca2+ to relieve salt stress on cucumber seedlings was investigated. The results revealed that grafting (G), Ca2+, and their interaction significantly influenced plant growth, osmotic adjustment substances, enzyme activities, and iron distribution. Under salt stress, grafting increased the absorption of potassium ion (K+) and Ca2+ in cucumber stems and leaves, but compared with NG, it significantly reduced the accumulation of Na+ in those parts by 61.58–89.40%. Moreover, supplication suitable Ca2+ content had a similar effect. Supplemental Ca2+ promoted the shoot and root biomass. The 10 mM L−1 Ca2+ had the highest biomass, compared with CK and NG, an increase of 49.95% and 20.47%, respectively; the lowest sodium ion (Na+). The highest Ca2+ accumulation in cucumber stem and leaves was found in 10 mM L−1 Ca2+ treatment. Supplemental Ca2+ increased free proline (Pro) and decreased malondialdehyde (MDA) content during the entire salt stress period. At 11 days, compared with 0 mM L−1 Ca2+ treatment, pro content was increased by 4.70–25.31, and MDA content was decreased by 1.08–4.90 times, respectively. Superoxide dismutase (SOD) activity, relative growth rate of plant height (PH), and stem volume (SV), and K+/Na+ and K+/Ca2+ in cucumber leaves had significantly negative correlations with a salt damage score. The combination of grafting and supplemental 5–20 mM L−1 Ca2+ relieved salt damage to cucumber seedlings. The best synergistic effect was obtained with grafting and 10 mM L−1 Ca2+ treatment.

The effect of oral calcium boluses at parturition on blood metabolites and milk yield in grazing Holstein cattle

The objective of this study was to assess the effect of oral calcium boluses at parturition on plasma total calcium (tCa), phosphorus (P), total magnesium (tMg), beta hydroxybutyrate (BHB) and milk yield during the postpartum (pp) of grazing Holstein cows. The study was conducted on a seasonal grazing dairy in Chile. Prepartum cows were fed an anionic diet (-86 mEq/kg DM). In 2019, 10 cows of parity 2, 3, and ≥ 4, respectively, were randomly assigned at parturition to a treatment group (n=30), receiving 2 boluses of oral Ca, (CaCl2, providing 44 g Ca) 24 h apart, and matched by parity to a control group (n=30). A blood sample was obtained at d 1, 2, 3, 4 and 7 pp. Milk yield was recorded until 30 d pp. Minerals and milk yield were analysed by ANOVA for repeated measures. Treatment had no effect on tCa in parity 2 cows. However, in lactation 3, Ca supplementation increased the concentration of tCa at d 2 and 3 pp, and in lactation ≥ 4 boluses tended to increase tCa at d 2 pp. Higher BHB concentrations at d 4 pp were found in treated cows than in the control cows. Milk yield in lactation 2 was lower in the treated than the control group. In lactations ≥ 3, milk yield was higher in the treated than the control group. In conclusion, two oral Ca boluses at parturition 24 h apart in grazing cattle fed anionic prepartum diets, improved Ca status and milk yield during the postpartum period in cows ≥ 3 lactations.

The effect of regular resistance exercise, vitamin D, and calcium supplements on the gastrocnemius muscle in rats in the post-menopausal period: An experimental study.

Background Menopause is the natural termination of menstruation which affects the quality and important aspects of women's life.Objective To evaluate the effect of regular resistance training (Ex) with vitamin D (Vit. D) and calcium (Ca) supplements in the postmenopausal period on muscle tissue in rats.Materials and Methods In this experimental study, 72 female Wistar rats (8-10-wk old) were randomly divided into control, placebo, Vit. D, Ca, Ex, Ca + Vit. D, Ex + Ca, Ex + Vit. D, and Ex + Ca + Vit. D groups. Control and placebo groups were fed with a standard diet and sesame oil, respectively. Two month after the ovariectomy, Ex, Ca (35 mg/kg), and Vit. D (10000 IU) were administred in all groups except the control. The number of muscle and inflammatory cells, fiber diameter, endomysium thickness, and degenerative collagen fiber area were assessed through hematoxylin-eosin staining.ResultsMuscle cell number was increased in the Ex + Vit. D + Ca, Vit. D + Ex, and Vit. D groups compared to the control group; also, inflammatory cell number showed significant increase in the Ex + Vit. D + Ca (12 5.46), Vit. D + Ex (14 3.25), Ex (13 4.08), Vit. D (11 3.26), Ca + Vit. D (10 1.01), and Ca + Ex (9 2.87) groups. Muscle fiber diameter in the Ex + Vit. D + Ca and Vit. D + Ex groups was higher than the other groups. Endomysium thickness was significantly decreased in the Ex + Vit. D + Ca and Vit. D + Ex groups compared to the control and placebo groups (p 0.001). Degenerative collagen fiber area showed a significant increase in the Ex + Vit. D + Ca and Vit. D + Ex groups (p 0.001) comparison with the control group.Conclusion Regular resistance exercise, Vit. D, and Ca supplements can improve muscle morphological features in the postmenopausal period.

BSA-lysozyme coated NaCa2HSi3O9 nanorods on titanium for cytocompatibility and antibacterial activity

Extracellular supplement of Ca and Si accelerates osteogenisis and angiogenisis during bone repair. Ca-Si-based ceramics are biodegradable and can release Ca and Si ions efficiently. However, locally high alkalinity induced by excessively rapid degradation limits their application. In this paper, NaCa2HSi3O9 (NCS) nanorods were fabricated on Ti by micro-arc oxidation and hydrothermal treatment; protein layers consisted of different rations of bovine serum albumin (BSA) and lysozyme (LYS) were prepared on NCS nanorods by spinning coating and thermal stabilization. The microstructure, ion releasing and wettability of coatings were observed; osteoblast and endotheliocyte behaviors, as well as bacteria response in vitro, were evaluated. The protein layer did not change microstructure and phase composition of nanorods but acted as a barrier isolating nanorods from contacting medium, and it results in slowing down the degradation of nanorods. The reduced increase of pH value, released Ca and Si ions and incorporation of LYS in BSA protein layer gave NCS nanorods improved MC3T3-E1 and HUVECs response, compared with Ti. Meanwhile, the protein layers except pure LYS endowed nanorods with a highly antibacterial effect against staphylococcus aureus and escherichia coli simultaneously, indicating the key role of BSA in resisting antibacterial adhesion. NCS nanorods with BSA and LYS composited protein layers should be a potential coating applied on Ti implants for increasing osseointegration.

Effects of Lemon Beverage Containing Citric Acid with Calcium Supplementation on Bone Metabolism and Mineral Density in Postmenopausal Women: Double-Blind 11-Month Intervention Study

A critical factor for preventing osteoporosis after menopause is attenuation of the accelerated turnover rate of bone metabolism. The present randomized controlled study was conducted to clarify the effects of a lemon beverage with calcium (Ca) supplementation that makes use of the chelating action of citric acid. Comprehensive evaluations of bone were performed by assessments of bone mineral density (BMD) and biomarkers related to bone turnover. Seventy-nine postmenopausal women were enrolled and asked to participate in an 11-month continuous intake of the test beverages. The subjects were divided into three groups: those who consumed a lemon beverage containing citric acid with Ca supplementation (LECA group), those who consumed a lemon beverage containing citric acid without Ca supplementation (LE group), and those who consumed no test beverage (control group). Using a double-blind protocol, subjects in the LECA and LE groups consumed one bottle containing 290 mL of the test beverage each day. The ratio of change in BMD after 11 months was significantly higher in the LECA group as compared to the control and LE groups. The LECA group also showed significant decreases in concentrations of tartrate-resistant acid phosphatase 5b (TRACP-5b), a bone resorption marker, and bone alkaline phosphatase (BAP) as compared to the other groups, as well as a significant decrease in concentration of osteocalcin (OC), a bone formation marker, as compared to the LE group. Based on our findings, we speculated that bone resorption and bone formation in postmenopausal women might be suppressed along with an increase in Ca resorption caused by chelation of citric acid in association with continuous ingestion of a Ca-supplemented lemon beverage containing citric acid, resulting in suppression of high bone metabolic turnover. In addition, the results provide information regarding BMD maintenance in the bones of the trunk, including the lumbar spine and proximal femur.

Effect of antepartum vitamin D3 (cholecalciferol) and postpartum oral calcium administration on serum total calcium concentration in Holstein cows fed an acidogenic diet in late gestation

Several strategies are available to control periparturient hypocalcaemia in dairy cows. Three complementary strategies were applied in this study: feeding a low DCAD (acidogenic) ration during late gestation, oral vitamin D3 (cholecalciferol) administration in late gestation, and oral Ca administration immediately after parturition. Multiparous Holstein cows (n = 240) were fed an acidogenic ration in late gestation and randomly assigned to one of three treatment groups. Group A (n = 80) were fed the acidogenic diet without supplementary Ca or cholecalciferol. Group Ca + A (n = 80) received 50 g of Ca as an oral bolus at calving and 12 h later. Group D3 + Ca + A (n = 80) were administered 3 mg of cholecalciferol orally each day starting 3 to 5 days before the anticipated calving date and 50 g of Ca as an oral bolus at calving and 12 h later. Blood and urine samples were obtained periodically from a random subset of 20 cows in each group from day 5 antepartum to day 21 postpartum and selected analytes measured. Data was analyzed using mixed models analysis. Serum Ca concentrations in group D3 + Ca + A were higher 12 h before and at parturition, compared to the two other groups. Oral Ca administration transiently increased mean serum Ca concentrations at 6 h after treatment initiation in groups D3 + Ca + A and Ca + A. We conclude that daily oral administration of 3 mg of cholecalciferol for up to 5 days before calving, combined with feeding an acidogenic ration in late gestation and oral Ca immediately after parturition, provided the highest periparturient serum Ca concentrations.

The Association Between Serum Magnesium Level and Microalbuminuria in Type 2 Diabetes Mellitus Patients

Background: Diabetic nephropathy occurs in 20 - 30% of diabetic cases globally, and microalbuminuria (MA) is the first symptom of this disorder. Some studies have suggested that there is an association between the serum magnesium (Mg) level and MA. Objectives: Therefore, we investigated the association between the serum Mg level and MA in type 2 diabetes mellitus (T2DM) patients. Methods: We conducted a cross-sectional study on 122 subjects with T2DM. We categorized them into two groups of microalbuminuria (MA) and non-microalbuminuria (NMA) according to their urine albumin-creatinine ratio (UACR). MA was considered as a UACR of 30 to 300 mg/g. Participants were excluded if they had the following conditions: The age of under 16 years, cardiac, renal, or hepatic disorders, using corticosteroids, diuretics, Mg /calcium (Ca) supplements, and antiepileptic drugs, heavy physical activity within 24 hours before the test, pregnant and breastfeeding women, febrile patients, and patients who were unwilling to participate in the study. The analysis was performed using SPSS version 15. A P-value &lt; 0.05 was considered significant. Results: Among the patients, 50.81% were male. Also, the mean body mass index (BMI) of the NMA group was greater than the MA group (29.84 ± 5.64 vs. 27.31 ± 3.14, P-value = 0.003). Mg levels of the MA and NMA groups showed no significant differences (2.13 ± 0.42 and 2.10 ± 0.43, respectively; P-value = 0.67). Overall, data analysis provided no significant difference between Mg level and the urine albumin concentration between the MA and NMA groups (P-value = 0.21 and 0.81, respectively.). Conclusions: Serum Mg level and MA have no significant relationship. Further prospective studies are needed to assay this issue.

Regional Citrate Anticoagulation Protocol for Patients with Presumed Absent Citrate Metabolism.

Regional citrate anticoagulation (RCA) is not recommended in patients with shock or severe liver failure. We designed a protocol with personalized precalculated flow settings for patients with absent citrate metabolism that abrogates risk of citrate toxicity, and maintains neutral continuous KRT (CKRT) circuit calcium mass balance and normal systemic ionized calcium levels. A single-center prospective cohort study of patients in five adult intensive care units triaged to the CVVHDF-RCA "Shock" protocol. Of 31 patients included in the study, 30 (97%) had AKI, 16 (52%) had acute liver failure, and five (16%) had cirrhosis at the start of CKRT. The median lactate was 5 mmol/L (interquartile range [IQR], 3.2-10.7), AST 822 U/L (IQR, 122-2950), ALT 352 U/L (IQR, 41-2238), total bilirubin 2.7 mg/dl (IQR, 1.0-5.1), and INR two (IQR, 1.5-2.6). The median first hemofilter life censored for causes other than clotting exceeded 70 hours. The cumulative incidence of hypernatremia (Na >148 mM), metabolic alkalosis (HCO3- >30 mM), and hypophosphatemia (P<2 mg/dl) were one out of 26 (4%), zero out of 30 (0%), and one out of 30 (3%), respectively, and were not clinically significant. Mild hypocalcemia occurred in the first 4 hours in two out of 31 patients, and corrected by hour 6 with no additional Ca supplementation beyond the per-protocol administered Ca infusion. The maximum systemic total Ca (tCa; mM)/ionized Ca (iCa; mM) ratio never exceeded 2.5. The Shock protocol can be used without contraindications and is effective in maintaining circuit patency with a high, fixed ACDA infusion rate to blood flow ratio. Keeping single-pass citrate extraction on the dialyzer >0.75 minimizes the risk of citrate toxicity even in patients with absent citrate metabolism. Precalculated, personalized dosing of the initial Ca-infusion rate from a table on the basis of the patient's albumin level and the filter effluent flow rate maintains neutral CKRT circuit calcium mass balance and a normal systemic iCa level.

Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery

BackgroundSurgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE). ObjectiveThe aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis. Material and methodsData on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study. ResultsThe concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002). ConclusionIOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.