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Sodium glycerophosphate and prescribed calcium concentrations in pediatric parenteral nutrition: a retrospective observational study and economic evaluation

Abstract

Background

The risk of precipitation limits calcium and phosphate concentrations that can be administered parenterally to pediatric patients. As an alternative to dipotassium phosphate, sodium glycerophosphate (NaGlyP) is claimed to reduce the risk of precipitation in solutions for parenteral administration.

Objectives

To determine the calcium concentrations, NaGlyP, and dipotassium phosphate prescribed in pediatric parenteral nutrition orders and the cost–benefit of the organic phosphate.

Methods

We retrospectively collected cross-sectional data for parenteral nutrition orders from September 2014 to August 2015 for pediatric patients including neonates and children aged <18 years who were admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Calcium concentration, calcium concentration adjustments, and costs of phosphate used per bag were analyzed.

Results

Of 2,192 parenteral nutrition orders, NaGlyP was used in 2,128 (97.1%) with calcium concentrations in the range of 0.84–139.91 mmol/L, which were significantly higher than calcium concentrations used with dipotassium phosphate (0.00–12.21 mmol/L, P < 0.001). There was no report of visible precipitation. Median costs of NaGlyP and dipotassium phosphate used per unit bag were not significantly different (35.88 and 41.25 Thai baht [THB] or 1.04 and 1.20 USD per bag, respectively, P>0.99; (1 USD equivalent to 34.241 THB U.S. Federal Reserve Bank G5.A annual average rate 2015).

Conclusions

Higher calcium concentrations could be achieved without increasing the direct cost per unit bag significantly as a result of using NaGlyP, an alternative to dipotassium phosphate as a source of phosphate for patients who require high amounts of calcium in parenteral nutrition.

Open access
21st Century era of anatomy
Open access
Anatomy of the vasculature supplying hepatobiliary structures and celiac trunk branching patterns in the Thai population

Abstract

Background

Knowledge of the anatomy of the celiac trunk (CT) and arterial supply of the hepatobiliary system is essential for surgical and interventional radiological treatment of upper abdominal diseases.

Objectives

To determine the branching patterns of the CT and variation in origin and type of the right hepatic artery (RHA), left hepatic artery (LHA), and cystic artery (CA).

Methods

The anatomy of the CT in 100 cadavers from Thai adult donors was observed in 3 aspects: its branching pattern, the origin of the RHA and LHA, and the origin of the CA and its relation to the common bile duct (CBD) and common hepatic duct (CHD).

Results

The majority of the CT branching pattern was categorized as the type II classical pattern, which has 3 branches: the left gastric artery (LGA), splenic artery (SA), and common hepatic artery (CHA). The RHA branched from proper hepatic artery in 67 cadavers. The origin of the accessory RHA was either from the abdominal aorta or superior mesenteric artery (SMA), whereas the replaced RHA originated from the CHA, SMA, or CT. The accessory LHA ramified from CHA (2 cases) and LGA (1 case). The replaced LHA was found in 30 cadavers and 29 arose from the CHA. The single and double types of CA were found in 94 and 4 cadavers, respectively. In all, 57% of single CA passed posteriorly and 39% passed anteriorly to the CBD and CHD.

Conclusions

To lower posttreatment complications, variations in the anatomy and the vascular supply of hepatobiliary structures should be considered.

Open access
Behavioral and histopathological studies of cervical spinal cord contusion injury in rats caused by an adapted weight-drop device

Abstract

Background

Models of spinal cord injury (SCI) caused by weight-drop devices to cause contusion have been used extensively, and transient behavioral deficits after thoracic injury have been demonstrated. The severity of the injury caused by the device should be mild enough to allow recovery.

Objective

To determine whether our adapted weight-drop device with a small tip can effectively induce mild hemicontusion at the level of the fifth cervical vertebra.

Methods

We divided 15 adult male Sprague Dawley rats into groups of 5 for the following treatments: sham (SH, laminectomy only), mild (MSCI) or severe SCI (SSCI). Behavioral tests and histopathology were used before (day 1) and after the treatment on days 3, 7, 14, 21, 28, and 35 to assess the injury.

Results

Rats with SSCI showed a significant somatosensory deficit on days 3 and 7 compared with rats in the SH group, recovering by day 14. In a horizontal-ladder test of skilled locomotion, rats with SSCI showed a significant increase in error scores and percentage of total rungs used, and a decrease in the percentage of correct paw placement compared with rats in the SH group. There was greater recovery to normal paw placement by rats with MSCI than by rats with SSCI. These behavioral deficits were consistent with histopathology using hematoxylin and eosin counterstained Luxol fast blue, indicating the degree of injury and lesion area.

Conclusions

Mild hemicontusion caused by the adapted device can be used to evaluate SCI and provides a model with which to test the efficacy of translational therapies for SCI.

Open access
Changes in sperm quality and testicular structure in a rat model of type 1 diabetes

Abstract

Background

Chronic hyperglycemia is a characteristic of diabetes mellitus (DM). Long-lasting hyperglycemia can generate oxidative stress and reactive oxygen species. The effect of this condition on sperm quality and spermatogenesis leads to male infertility and reproductive dysfunction.

Objectives

To investigate changes in sperm quality, morphology of testicular structure, and stage of development of seminiferous tubules in a streptozotocin (STZ)-induced rat model of type 1 DM.

Methods

We divided 15 male Sprague Dawley rats into 2 groups. DM was induced in 7 rats using STZ (60 mg/kg intraperitoneally), while the other 8 were treated with citrate buffer as a vehicle control group. Rat semen was collected for quality measurements including motility, normal morphology, and concentration. Morphological changes in testicular structure and stage of development of seminiferous tubules were investigated by histology with hematoxylin and eosin (HE) staining.

Results

Significant decreases in all parameters of sperm quality and testicular weight were found in rats with induced DM. Moreover, abnormal morphology of seminiferous tubules including separation of the germinal epithelium, vacuolization, luminal sloughing of germ cells, and tubular atrophy was increased significantly in these rats, while the proportion of their seminiferous tubules at an early stage of development was significantly higher, but was dramatically decreased in the late stage of development when compared with that in vehicle-treated control rats.

Conclusions

DM has adverse effects on sperm quality, testicular structure, and development of seminiferous tubules. These findings may reflect the male infertility and reproductive dysfunction seen in patients with type 1 DM.

Open access
Cytotoxic responses of human chondrocytes to bupivacaine, levobupivacaine, and ropivacaine

Abstract

Background

Intra-articular injections of local anesthetics are used commonly in articular surgery. However, chondrocyte viability and metabolism may be adversely affected by various anesthetics.

Objectives

To assess the chondrotoxic effects of bupivacaine, levobupivacaine, and ropivacaine on human chondrocytes and elucidate possible mechanisms of chondrocyte death.

Methods

Cultured human chondrocytes (CHON-001) were exposed to 0.25% or 0.5% of bupivacaine, levobupivacaine, and ropivacaine in vitro. Cell viability was determined by flow cytometry after 15, 30, 60, and 120 min of exposure. Chondrocyte reactive oxygen species (ROS) production was measured every 10 min for up to 1 h using 2ʹ,7ʹ-dichlorodihydrofluorescein staining. Chondrocyte production of glycosaminoglycan was measured by capillary electrophoresis. NO production was measured using a colorimetric assay kit.

Results

We found a significant increase in chondrotoxicity dependent on exposure time and concentration of the anesthetic. At 60 min, chondrocyte viability was significantly (P < 0.05) decreased when exposed to 0.5% levobupivacaine (32.5%), or 0.25% or 0.5% bupivacaine (34.3% or 46.5%, respectively) compared with exposure to phosphate-buffered saline (PBS) vehicle as a control. Cell death at 120 min was mainly necrosis. There was no difference in viability after treatment with either concentration (0.25% or 0.5%) of ropivacaine at any time compared with exposure to PBS. We found increased production of NO, while ROS decreased after exposure to any of the anesthetics tested.

Conclusions

Ropivacaine may be safer than bupivacaine or levobupivacaine as an intra-articular analgesic. Chondrotoxicity of anesthetics in vitro may be mediated via a reactive nitrogen species-dependent pathway.

Open access
Neural cell adhesion molecule (NCAM) and polysialic acid–NCAM expression in developing ICR mice

Abstract

Background

Coexpression of polysialic acid (PSA)–neuronal cell adhesion molecule (NCAM) with immature neuronal markers is used to indicate the developmental state of neurons generated in the subgranular zone (SGZ) of adult hippocampus. PSA–NCAM is highly expressed throughout the embryonic and juvenile mammalian brain, but heavily downregulated in adult brain.

Objective

To visualize the expression profiles of NCAM/PSA–NCAM in the dentate SGZ of the hippocampus in developing ICR mice.

Methods

Cellular distribution, expression, and developmental changes of NCAM/PSA–NCAM were studied in ICR mice at embryonic age 17 days (E17); and similarly at postnatal ages P3, P5, and P7. The SGZ was studied using NCAM and PSA–NCAM immunoreactive staining with or without hematoxylin counterstaining. Western blotting was used to confirm protein expression levels.

Results

NCAM expression was localized to the surface of neurons and glia and was higher in postnatal mice than it was in embryonic mice. PSA–NCAM was found in cytoplasm and membrane of neural cells, more densely staining in the dentate SGZ at P7, but no staining found at E17. Western blotting of brain tissues also showed expression of both PSA–NCAM and NCAM increased significantly at P5 and P7 compared with expression at P3.

Conclusions

Progressive increase in NCAM expression occurs in the SGZ during embryogenic and postnatal development. PSA–NCAM was not expressed in embryonic ICR mice, but was increased after birth and highly localized in the SGZ at P7. This NCAM expression pattern in the developing brain indicating structural plasticity and neurogenesis may be useful for study of brain repair.

Open access
Proteomics study of the antifibrotic effects of α-mangostin in a rat model of renal fibrosis

Abstract

Background

Renal fibrosis is a consequence of a “faulty” wound-healing mechanism that results in the accumulation of extracellular matrix, which could lead to the impairment of renal functions. α-Mangostin (AM) may prevent the formation of liver fibrosis, but there has yet to be a conclusive investigation of its effect on renal fibrosis.

Objectives

To investigate the renoprotective effect of AM against thioacetamide (TAA)-induced renal fibrosis in rats at the morphological and proteomic levels.

Methods

We divided 18 male Wistar rats into 3 groups: a control group, a TAA-treated group, and a TAA + AM group. The various agents used to treat the rats were administered intraperitoneally over 8 weeks. Subsequently, the morphology of renal tissue was analyzed by histology using Sirius Red staining and the relative amount of stained collagen fibers quantified using ImageJ analysis. One-dimensional gel liquid chromatography with tandem mass spectrometry (GeLC-MS/MS) was used to track levels of protein expression. Proteomic bioinformatics tools including STITCH were used to correlate the levels of markers known to be involved in fibrosis with Sirius Red-stained collagen scoring.

Results

Histology revealed that AM could reduce the relative amount of collagen fibers significantly compared with the TAA group. Proteomic analysis revealed the levels of 4 proteins were modulated by AM, namely CASP8 and FADD-like apoptosis regulator (Cflar), Ragulator complex protein LAMTOR3 (Lamtor3), mitogen-activated protein kinase kinase kinase 14 (Map3k14), and C-Jun-amino-terminal kinase-interacting protein 3 (Mapk8ip3).

Conclusion

AM can attenuate renal fibrosis by the suppression of pathways involving Cflar, Lamtor3, Map3k14, and Mapk8ip3.

Open access
Open access