Lack of Nephrotoxicity by 6% Hydroxyethyl Starch 130/0.4 during Hip Arthroplasty

2014 ◽  
Vol 121 (5) ◽  
pp. 948-958 ◽  
Author(s):  
Anne Sophie Pinholt Kancir ◽  
Lina Pleckaitiene ◽  
Torben Bæk Hansen ◽  
Niels Peter Ekeløf ◽  
Erling Bjerregaard Pedersen
Keyword(s):  
Renal Function ◽  
Angiotensin Ii ◽  
Hydroxyethyl Starch ◽  
Hip Arthroplasty ◽  
Recovery Period ◽  
Plasma Concentrations ◽  
Harmful Effect ◽  
Controlled Study ◽  
Control Group ◽  
Urine Albumin

Abstract Background: Hydroxyethyl starch (HES) is commonly used as plasma expander during surgery but may be nephrotoxic as seen in studies in patients with sepsis. The authors hypothesized that the possible nephrotoxicity of 6% HES 130/0.4 could be revealed by measurements of urinary excretion of neutrophil gelatinase–associated lipocalin (u-NGAL) in patients with normal renal function during hip arthroplasty. Methods: In this randomized, double-blinded, placebo-controlled study, 40 patients referred for hip arthroplasty received either 6% HES 130/0.4 or isotonic saline 0.9%; 7.5 ml/kg during the first hour of surgery and 5 ml/kg during the following hours; 38 patients completed the study. U-NGAL, urine albumin, blood pressure, and plasma concentrations of creatinine, renin, NGAL, albumin, angiotensin-II, and aldosterone were measured before, during, and after surgery. U-NGAL was defined as primary outcome. Results: There were no significant differences in U-NGAL (mean difference and 95% CI), plasma creatinine, and urine albumin during the study. U-NGAL and urine albumin increased significantly in both groups the morning after surgery but was normalized at follow-up after 10 to 12 days. Mean arterial pressure was significantly higher during the recovery period in the HES group compared with that in the control group (91 [13] and 83 [6] mmHg, mean [SD], P < 0.03). Plasma renin and angiotensin-II were nonsignificantly different in both groups, whereas plasma aldosterone was significantly lower in the HES group. Plasma albumin was reduced in both groups, but to a significantly lower level in the HES group. Conclusion: The study showed no evidence of a harmful effect of intraoperative infusion of 6% HES 130/0.4 on renal function in patients during hip arthroplasty.

Evaluation of plasma free amino acid and carnitine levels in patients with cesarean scar pregnancy

2020 ◽  
Vol 23 ◽  
Author(s):  
Omer Tammo ◽  
Hacer Uyanikoglu ◽  
İsmail Koyuncu
Keyword(s):  
Amino Acid ◽  
Pregnant Women ◽  
Free Amino Acid ◽  
Free Amino ◽  
Plasma Concentrations ◽  
Myometrial Invasion ◽  
Controlled Study ◽  
Control Group ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar

Aim and Objective: This study aimed to explore the plasma free amino acid (FAA) and carnitine levels in pregnant women with cesarean scar pregnancy (CSP), and to compare them with those of healthy pregnant women. Materials and Methods: This prospective and randomized controlled study was conducted in patients admitted to Harran University Medical Faculty Hospital Obstetrics Clinic between January 2018 and January 2019. A total of 60 patients were included in the study, and the patients were divided into two groups: CSP group (n = 30) and healthy pregnant group as the control group (n = 30). The blood samples were taken from the participants between 7 - 12 weeks of gestation. Twentyseven carnitines and their esters and 14 FAAs were analysed by liquid chromatography – mass spectrometry (LC-MS/MS). Results: The mean plasma concentrations of some carnitines, including C2, C5, C5-OH, C5-DC, C6, C8-1, C12, C14, C14- 1, C14-2, C16, C16-1, C18, and C18-1 were significantly higher in CSP group than in the control group. However, other carnitines, including C0, C3, C4, C4-DC, C5-1, C6-DC, C8, C8-DC, C10, C10-1, C18-1-OH, and C18-2 were similar in both groups. The plasma levels of some FAAs, including Methyl Glutaryl, Leu, Met, Phe, Arg, Orn, and Glu values were significantly higher in CSP group than in the control group. However, there was no statistically significance in other FAA levels, including Val, Asa, Tyr, Asp, Ala, Cit, and Gly between the two groups. Additionally, Pearson’s correlation analysis showed that there were significantly positive correlations between many FAA and carnitine values. Conclusion: Since several plasma carnitine and FAA levels were higher in CSP group than in the control group, we think that scar pregnancy increases metabolic need for myometrial invasion. Also, we think that these results may be useful in clinical practice for CSP diagnosis.

scholarly journals The Lasting Effect of Discontinuing Zoledronic Acid On Periprosthetic Bone Mineral Density Five Years After Total Hip Arthroplasty

2021 ◽  
Author(s):  
Allen Herng Shouh Hsu ◽  
Chun-Hsien Yen ◽  
Yu-Der Lu ◽  
Feng-Chih Kuo ◽  
Cheng-Ta Wu ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Renal Function ◽  
Zoledronic Acid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Control Group ◽  
Mineral Density ◽  
Short Term ◽  
Periprosthetic Bone ◽  
Lasting Effect

Abstract Background: Previous study has shown that a short-term use of zoledronic acid (ZA) after cementless total hip arthroplasty (THA) significantly increases bone mineral density (BMD) over the proximal femur and inhibits bone turnover markers (BTMs) after two years. However, could the discontinuation of ZA have a lasting effect is of interest.Method: This is an extension study of a two-year prospective randomized controlled trial on 54 cementless THA treated with either two doses of ZA or placebo. We compared BTMs [alkaline phosphatase (ALP); osteocalcin (OC); procollagen 1 intact N-terminal propeptide (P1NP)], serum calcium, renal function, radiological findings, and functional outcomes (Harris hip score and UCLA activity score) from baseline to 5 years post-THA in 49 patients, and periprosthetic BMD of the seven Gruen zones in 19 patients.Result: All patients had well-functioning hip prostheses, normal renal function, and normal serum calcium levels at 5-year follow-up. At the fifth year, the BMD levels were not statistically different between the two groups, but the change in BMD from baseline (BMD change ratios) in ZA group were significantly increased in zone 2, 4, and 6 as compared with control group. Parallel to that, in ZA group, levels of ALP were significantly lower at the fifth year; OC were significantly lower at the second and the fifth year; P1NP were significantly lower from 6 weeks to 2 years as compared with those in control group.Conclusion: This study demonstrates the lasting effect of a two-dose ZA given within one year after THA on bone metabolism and periprosthetic BMD at five years. The short-term dosing of ZA followed by a 4-year drug holiday had no adverse events and resulted in significant inhibition of periprosthetic bone loss and BTMs.Trial Registration:This extension study on a randomized, open label, single-center clinical trial was conducted under Institutional Review Board of Chang Gung Memorial Hospital Protocol Records 98-1150A3; 105-1296C1; 105-7004D, and was registered July 19th, 2016 on public registry ClinicalTrials.gov trial registration number NCT02838121.

scholarly journals Combination Preemptive Peripheral Nerve Block in Limb Surgery. A Prospective Study

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 388
Author(s):  
I-Cheng Lu ◽  
Shu-Hung Huang ◽  
David Vi Lu ◽  
Chun Dan Hsu ◽  
Sheng Hua Wu
Keyword(s):  
Pain Management ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Recovery Period ◽  
Controlled Study ◽  
Control Group ◽  
Single Shot ◽  
Early Recovery ◽  
The Impact

Background and objectives: Patients often suffer from moderate to severe pain during the early recovery period in orthopedic surgery. We investigated the impact of a single-shot preoperative peripheral nerve block (PNB) on post-anesthesia recovery parameters and interleukin (IL)-6 level during limb surgery. Materials and Methods: A prospective randomized controlled study was conducted, and patients scheduled for limb surgery were recruited. Sixty patients were randomly assigned to either the PNB group or control group, who received morphine as a primary analgesic. The peak verbal numeric rating scale (NRS) score in the post-anesthesia care unit (PACU) was evaluated as a primary outcome. We also recorded rescue analgesics requirement and wake-up time from anesthesia in the PACU. In addition, the change of plasma IL-6 level after incision was measured. Results: Fifty-two patients completed the study, 27 and 25 cases in the PNB and control group, respectively. Preemptive PNB significantly reduced peak NRS score in the PACU compared to control group. Lower rescue analgesics requirement and rapid wake-up from anesthesia were also noted in PNB group. The IL-6 concentration increased less in the PNB group at 2 h after incision. Conclusions: Preemptive PNB attenuates IL-6 expression 2 h after incision and improves pain management in the PACU. PNB was considered as an essential part of pain management in limb surgery.

Abstract 514: Jak2 Tyrosine Kinase Mediates Angiotensin II Renal Pathogenesis via its Pressor Dependent Actions

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Peter P Sayeski ◽  
Sung O Park ◽  
Annet Kirabo ◽  
Rebekah Baskin ◽  
Dale M Seth ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Renal Injury ◽  
Interstitial Fibrosis ◽  
Critical Role ◽  
Glomerular Sclerosis ◽  
Control Group ◽  
Mrna Levels ◽  
Ang Ii ◽  
Urine Albumin ◽  
Independent Events

We previously found that Jak2 kinase, expressed within vascular smooth muscle cells (VSMC), plays a critical role in angiotensin II (Ang II)-mediated hypertension. Given that Jak2 mediates both pressor-dependent and pressor-independent events, we sought to determine the role of blood pressure (BP), per se, on the deleterious effects of Jak2 within the kidney. To investigate this, three groups of mice were examined; i) wild type mice (Controls) that received Ang II infusion, ii) mice lacking Jak2 expression within the VSMC (VSMC Jak2 Null) that also received Ang II, and iii) Control mice that received Ang II plus an anti-hypertensive triple therapy (3Rx). After baseline BP recordings, Ang II was infused (1000 ng/kg/min, SC) to all groups and the 3Rx regimen (80 mg/L hydralazine, 5 mg/L reserpine, 30 mg/L hydrochlorothiazide in the drinking water) was initiated two days later to the 3Rx group, in order to maintain BP at similar levels to the VSMC Jak2 Null group. After 28 days of Ang II, mice were euthanized and the kidneys were assessed via histological, molecular, and functional approaches. Chronic Ang II infusion significantly increased the levels of intrarenal Ang II in all three groups; Control = 1,262±283 fmol/g, VSMC Jak2 Null = 1,655±666 fmol/g, and 3Rx = 2,174±588. While Ang II infusion significantly increased the mean BP in the Control group (152 ± 2 mm Hg), it was significantly, and similarly, lower in both the VSMC Jak2 Null and 3Rx groups (125 ± 5 mm Hg and 131 ± 5 mm Hg, respectively). Glomerular sclerosis was absent and interstitial fibrosis ranged from absent- mild- moderate, and was similar in all groups. The increases in i) perivascular infiltration of CD3+ lymphocytes, ii) CTGF gene expression, iii) tubule casts and iv) albuminuria that were observed in the Control mice, were significantly reduced in both the VSMC Jak2 Null and 3Rx groups. [CTGF mRNA Levels: Control = 100%±17, VSMC Jak2 Null = 70%±12*, 3Rx= 56%±17*. Urine Albumin (ng/day): Control = 414 ± 262, VSMC Jak2 Null = 138 ± 172*, 3Rx= 101 ± 89* (*, p<0.05 vs. Control)]. Thus, the early renal injury due to chronic Ang II infusion correlates with increased BP and not with the expression of VSMC-derived Jak2, suggesting that Jak2 contributes to early Ang II-mediated renal injury via its pressor-dependent actions.

Anterior quadratus lumborum block analgesia for total hip arthroplasty: a randomized, controlled study

2019 ◽  
pp. rapm-2019-100804 ◽  
Author(s):  
Promil Kukreja ◽  
Lisa MacBeth ◽  
Adam Sturdivant ◽  
Charity J Morgan ◽  
Elie Ghanem ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Pain Score ◽  
Hip Arthroplasty ◽  
Opioid Consumption ◽  
Controlled Study ◽  
Control Group ◽  
Patient Satisfaction Score ◽  
Total Hip ◽  
Quadratus Lumborum

Background and objectivesQuadratus lumborum (QL) block is a new regional analgesic technique for upper and lower abdominal surgeries as part of a multimodal analgesic regime. It has also been reported to relieve pain after total hip arthroplasty (THA). In this prospective, randomized, double-blind study, we compared QL block with control (no block) in patients undergoing primary THA.MethodsEighty patients undergoing primary THA surgery under spinal anesthesia were randomized into two groups, one with and one without QL block. The patients in both groups were randomized after sedation, positioning and ultrasound scanning. Both the patient and the researcher collecting data were blinded to the patient’s group assignment. Opioid consumption and visual analog scores (VAS) pain scores were measured at 12, 24, and 48 hours after surgery. Also, the ambulation distance, patient satisfaction, and length of stay were recorded.ResultsThe study analysis included 36 patients in the QL group and 35 patients in the control group. Both VAS pain score at 24 hours (difference −1.76, 95% CI −2.87 to −0.64) and cumulative opioid consumption were significantly lower in the QL group at 12, 12–24, 24, 24–48, and 48 hours after surgery as compared with the control group (difference at 48 hours −36.13, 95% CI −62.89 to −9.37) (p<0.05). However, there was no difference in pain score at 12 and 48 hours, nor in the ambulation distance and duration of hospital stay between the two groups. The patient satisfaction score was significantly higher in the QL group.ConclusionsOur preliminary data show that the QL block provided effective analgesia and decreased opioid requirements up to 48 hours after primary THA.Trial registration numberNCT03408483

scholarly journals Protective Effects of Liposomal Curcumin on Oxidative Stress/Antioxidant Imbalance, Metalloproteinases 2 and -9, Histological Changes and Renal Function in Experimental Nephrotoxicity Induced by Gentamicin

Antioxidants ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 325
Author(s):  
Adriana Elena Bulboacă ◽  
Alina Porfire ◽  
Sorana D. Bolboacă ◽  
Cristina Ariadna Nicula ◽  
Dana Gabriela Feștilă ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Renal Function ◽  
Plasma Concentrations ◽  
Control Group ◽  
Protective Effects ◽  
Histological Changes ◽  
Total Antioxidant ◽  
Antioxidant Parameters ◽  
Capacity Matrix ◽  
Total Oxidative Stress

Background: Our study aimed to assess the efficiency of Curcumin nanoformulation (LCC) on experimental nephrotoxicity induced by Gentamicin in rats. Methods: Six groups of seven rats were used: C—(control group) received saline solution i.p. (i.p. = intraperitoneal), G—gentamicin (G, 80 mg/kg body weight (b.w.)), GCC1 and GCC2—with G and CC solution (single dose of 10 mg/kg b.w.-CC1, or 20 mg/kg b.w.-CC2), GLCC1 (10 mg/kg b.w.) and GLCC2 (20 mg/kg b.w.) with G and LCC administration. Oxidative stress parameters (NOx = nitric oxide, MDA = malondialdehyde, TOS = total oxidative stress), antioxidant parameters (CAT = catalase, TAC = total antioxidant capacity), matrix metalloproteinases (MMP-2 and MMP-9), and renal function parameters (creatinine, blood urea nitrogen, and urea) were measured. Kidneys histopathologic examination was made for each group. Results: Pretreatment with CC and LCC in both doses had significantly alleviating effects on assessed parameters (NOx, MDA, TOS, CAT, TAC, MMP-2, and -9) as compared with the untreated group (p < 0.006). Histopathological aspect and renal function were significantly improved in CC and LCC groups. Liposomal formulation (LCC) showed higher efficiency on all examined parameters compared to CC (p < 0.006). Conclusions: Our results demonstrated improving renal function and kidney cytoarchitecture, oxidative stress/antioxidant/balance, and MMPs plasma concentrations with better dose-related efficacity of LCC than CC.

scholarly journals Polyphenol-rich extract of Ocimum gratissimum leaves prevented toxic effects of cyclophosphamide on the kidney function of Wistar rats

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Quadri K. Alabi ◽  
Rufus O. Akomolafe ◽  
Joseph G. Omole ◽  
Ayodeji Aturamu ◽  
Mokolade S. Ige ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Renal Function ◽  
Low Cost ◽  
Plasma Concentrations ◽  
Kidney Injury ◽  
Albumin Concentration ◽  
Ocimum Gratissimum ◽  
Reactive Protein ◽  
Urine Albumin ◽  
Aldosterone Production

Abstract Background Cyclophosphamide (CP) is one of the potent and low cost chemotherapy used in clinical setting against a variety of tumors. However, its association with nephrotoxicity limits its therapeutic use. Ocimum gratissimum leaf is a medicinal plant with numerous pharmacological and therapeutic efficacies, such as antioxidant, anti-inflammation, and anti-apoptotic properties. Methods The present study was designed to evaluate the protective effect of Ocimum gratissimum (OG) against CP-induced kidney dysfunction in rats. Rats were pre-treated with 400 mg/kg b.w. of leave extract of Ocimum gratissimum (Ocimum G.) for 4 days and then 50 mg/kg b.w. of CP was co-administered from day 5 to day 7 along with Ocimum G. Markers of renal function and oxidative stress, food and water intake, electrolytes, aldosterone, leukocytes infiltration, inflammation and histopathological alteration were evaluated. Results Obvious renal inflammation and kidney injuries were observed in CP treated groups. However, administration of leave extract of Ocimum G. prevented oxidative stress, kidney injuries, attenuated inflammation, increased aldosterone production and reduced sodium ion and water loss in rats. The plasma creatinine, urea and urine albumin concentration were normalized after the administration of Ocimum G. extract in rats treated with CP. Ocimum G. also decreased the plasma concentrations of Interleukin-(IL)-6, C-reactive protein and activity of myeloperoxidase and malondialdehyde in CP treated rats. Conclusion Ocimum G. prevented kidney injury and enhanced renal function via inhibiting inflammation and oxidant-induced CP toxicity. The efficacy of Ocimum G. is related to the presence of various phytochemicals in the plant.

scholarly journals Serum cobalt concentrations remain at low levels at a minimum of 20 years following metal-on-metal total hip arthroplasty

2020 ◽  
Vol 9 (3) ◽  
pp. 146-151 ◽  
Author(s):  
Wenzel Waldstein ◽  
Ulrich Koller ◽  
Bernhard Springer ◽  
Paul Kolbitsch ◽  
Wolfram Brodner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Control Group ◽  
Total Hip ◽  
Metal On Metal ◽  
Low Levels ◽  
Serum Cobalt

Aims Second-generation metal-on-metal (MoM) articulations in total hip arthroplasty (THA) were introduced in order to reduce wear-related complications. The current study reports on the serum cobalt levels and the clinical outcome at a minimum of 20 years following THA with a MoM (Metasul) or a ceramic-on-polyethylene (CoP) bearing. Methods The present study provides an update of a previously published prospective randomized controlled study, evaluating the serum cobalt levels of a consecutive cohort of 100 patients following THA with a MoM or a CoP articulation. A total of 31 patients were available for clinical and radiological follow-up examination. After exclusion of 11 patients because of other cobalt-containing implants, 20 patients (MoM (n = 11); CoP (n = 9)) with a mean age of 69 years (42 to 97) were analyzed. Serum cobalt levels were compared to serum cobalt levels five years out of surgery. Results The median cobalt concentration in the MoM group was 1.04 μg/l (interquartile range (IQR) 0.64 to 1.70) at a mean of 21 years (20 to 24) postoperatively and these values were similar (p = 0.799) to cobalt levels at five years. In the CoP control group, the median cobalt levels were below the detection limit (< 0.3 μg/l; median 0.15 μg/l, IQR 0.15 to 0.75) at 20 years. The mean Harris Hip Score was 91.4 points (61 to 100) in the MoM group and 92.8 points (63 to 100) in the CoP group. Conclusion This study represents the longest follow-up series evaluating the serum cobalt levels after 28 mm head MoM bearing THA and shows that serum cobalt concentrations remain at low levels at a mean of 21 years (20 to 24) after implantation. Cite this article: Bone Joint Res. 2020;9(3):145–150.

Renoprotective Effects of Artesunate against Renal Ischemia-Reperfusion Injury in Rat Model

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Bassim I Mohammed ◽  
Najah R Hadi ◽  
Jabber Huda ◽  
Galal Elkilany ◽  
RB Singh
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Tissue Injury ◽  
Ischemia Reperfusion ◽  
Plasma Concentrations ◽  
Kidney Tissue ◽  
Kidney Injury ◽  
Renal Ischemia ◽  
Control Group ◽  
Tissue Concentrations

Renal ischemia-reperfusion (Renal I/R) leads to acute kidney injury (AKI),a major kidney disease associated with an increasing prevalence and high mortality rates. A variety of experimental models,both in vitro and in vivo,have been used to study the pathogenic mechanisms of ischemic AKI and to test reno-protective strategies. Aim: To study potential protective effects of artesunate on renal I/R injury. Renal I/R injury was unilaterally induced in adult (3 to 5 months) male Sprague-Dawely rats,whose weights ranged from 180 to 390 g. Thereafter,the animals were pre-treated with artesunate intra-peritoneally,and at the end of reperfusion sacrificed humanely. Plasma,serum and tissue samples were obtained for analysis. Plasma concentrations of NGAL (neutrophil gelatinase associated lipocalin),an iron-trafficking protein involved in multiple processes such as apoptosis,innate immunity and renal development,and tissue concentrations of IL-18 (Interleukin-18) were measured via ELISA analysis. Serum urea and creatinine were also measured in the samples. Artesunate improved renal ischemia reperfusion,including renal function and brought about reductions in inflammatory mediators and kidney tissue injury. Plasma concentrations of NGAL and tissue concentrations of IL-18 were significantly (p < 0.05) lower in the artesunatepretreated group than in the vehicle and control groups. Furthermore,serum concentrations of urea and creatinine were significantly (p < 0.05) decreased in the pretreated group as compared to the control group. Artesunate can significantly improve renal function following I/R through down-regulation of inflammatory parameters and NGAL expression. Furthermore,it could serve as a potential therapy in ischemia reperfusion-induced acute kidney injury.

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