scholarly journals Effect of Cilastatin on Cisplatin-Induced Nephrotoxicity in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy

2021 ◽  
Vol 22 (3) ◽  
pp. 1239
Author(s):  
Matilde Zaballos ◽  
Mercedes Power ◽  
María Iluminada Canal-Alonso ◽  
María Ángeles González-Nicolás ◽  
Wenceslao Vasquez-Jimenez ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Fluid Management ◽  
Urine Volume ◽  
Chemotherapeutic Agents ◽  
Control Group ◽  
Specific Data ◽  
Preoperative Risk Factors ◽  
Hyperthermic Chemotherapy ◽  
Chemotherapy Perfusion ◽  
Nephroprotective Effect

Cisplatin is one of the most widely used chemotherapeutic agents in oncology, although its nephrotoxicity limits application and dosage. We present the results of a clinical study on prophylaxis of cisplatin-induced nephrotoxicity in patients with peritoneal carcinomatosis undergoing cytoreduction and hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC-cisplatin). Prophylaxis was with imipenem/cilastatin. Cilastatin is a selective inhibitor of renal dehydropeptidase I in the proximal renal tubule cells that can reduce the nephrotoxicity of cisplatin. Unfortunately, cilastatin is not currently marketed alone, and can only be administered in combination with imipenem. The study has a retrospective part that serves as a control (n = 99 patients receiving standard surgical prophylaxis) and a prospective part with imipenem/cilastatin prophylaxis corresponding to the study group (n = 85 patients). In both groups, we collected specific data on preoperative risk factors of renal damage, fluid management, hemodynamic control, and urine volume during surgery (including the hyperthermic chemotherapy perfusion), as well as data on hemodynamic and renal function during the first seven days after surgery. The main finding of the study is that cilastatin may exert a nephroprotective effect in patients with peritoneal carcinomatosis undergoing cytoreduction and hyperthermic intraperitoneal cisplatin perfusion. Creatinine values remained lower than in the control group (ANOVA test, p = 0.037). This translates into easier management of these patients in the postoperative period, with significantly shorter intensive care unit (ICU) and hospital stay.

Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from Compass Clinical Trial

2017 ◽  
Vol 38 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Kook-Hwan Oh ◽  
Seon Ha Baek ◽  
Kwon-Wook Joo ◽  
Dong Ki Kim ◽  
Yon Su Kim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Fluid Management ◽  
Urine Volume ◽  
Clinical Information ◽  
Additional Benefit ◽  
Volume Control ◽  
Control Group ◽  
Rapid Decline ◽  
Fluid Status

Introduction In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients. Subjects and methods This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information. Results The subjects ( N = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group ( n = 67) or to the control group ( n = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m2). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m2, p = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, p = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up. Conclusion Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.

scholarly journals Effects of a 14-Day Hydration Intervention on Individuals with Habitually Low Fluid Intake

2021 ◽  
Author(s):  
Aaron R. Caldwell ◽  
Megan E. Rosa-Caldwell ◽  
Carson Keeter ◽  
Evan C. Johnson ◽  
François Péronnet ◽  
...  
Keyword(s):  
Body Weight ◽  
Total Body Water ◽  
Fluid Intake ◽  
Urine Volume ◽  
Urine Osmolality ◽  
Body Water ◽  
Control Group ◽  
Intervention Phase ◽  
Total Body ◽  
Experimental Group

<b><i>Background:</i></b> Debate continues over whether or not individuals with low total water intake (TWI) are in a chronic fluid deficit (i.e., low total body water) [<xref ref-type="bibr" rid="ref1">1</xref>]. When women with habitually low TWI (1.6 ± 0.5 L/day) increased their fluid intake (3.5 ± 0.1 L/day) for 4 days 24-h urine osmolality decreased, but there was no change in body weight, a proxy for total body water (TBW) [<xref ref-type="bibr" rid="ref2">2</xref>]. In a small (<i>n</i> = 5) study of adult men, there were no observable changes in TBW, as measured by bioelectrical impedance, after increasing TWI for 4 weeks [<xref ref-type="bibr" rid="ref3">3</xref>]. However, body weight increased and salivary osmolality decreased indicating that the study may have been underpowered to detect changes in TBW. Further, no studies to date have measured changes in blood volume (BV) when TWI is increased. <b><i>Objectives:</i></b> Therefore, the purpose of this study was to identify individuals with habitually low fluid intake and determine if increasing TWI, for 14 days, resulted in changes in TBW or BV. <b><i>Methods:</i></b> In order to identify individuals with low TWI, 889 healthy adults were screened. Participants with a self-reported TWI less than 1.8 L/day (men) or 1.2 L/day (women), and a 24-h urine osmolality greater than 800 mOsm were included in the intervention phase of the study. For the intervention phase, 15 participants were assigned to the experimental group and 8 participants were assigned to the control group. The intervention period lasted for 14 days and consisted of 2 visits to our laboratory: one before the intervention (baseline) and 14 days into the intervention (14-day follow-up). At these visits, BV was measured using a CO-rebreathe procedure and deuterium oxide (D<sub>2</sub>O) was administered to measure TBW. Urine samples were collected immediately prior, and 3–8 h after the D<sub>2</sub>O dose to allow for equilibration. Prior to each visit, participants collected 24-h urine to measure 24-h hydration status. After the baseline visit, the experimental group increased their TWI to 3.7 L for males and 2.7 L for females in order to meet the current Institute of Medicine recommendations for TWI. <b><i>Results:</i></b> Twenty-four-hour urine osmolality decreased (−438.7 ± 362.1 mOsm; <i>p</i> &#x3c; 0.001) and urine volume increased (1,526 ± 869 mL; <i>p</i> &#x3c; 0.001) in the experimental group from baseline, while there were no differences in osmolality (−74.7 ± 572 mOsm; <i>p</i> = 0.45), or urine volume (−32 ± 1,376 mL; <i>p</i> = 0.89) in the control group. However, there were no changes in BV (Fig. <xref ref-type="fig" rid="f01">1</xref>a) or changes in TBW (Fig. <xref ref-type="fig" rid="f01">1</xref>b) in either group. <b><i>Conclusions:</i></b> Increasing fluid intake in individuals with habitually low TWI increases 24-h urine volume and decreases urine osmolality but does not result in changes in TBW or BV. These findings are in agreement with previous work indicating that TWI interventions lasting 3 days [<xref ref-type="bibr" rid="ref2">2</xref>] to 4 weeks [<xref ref-type="bibr" rid="ref3">3</xref>] do not result in changes in TBW. Current evidence would suggest that the benefits of increasing TWI are not related changes in TBW.

Analysis of Voiding Impairment after Prostate Biopsy and the Effect of Doxazosin Treatment: Outcomes from a Regional Cancer Center

2021 ◽  
pp. 1-6
Author(s):  
Yi Zheng ◽  
Fuding Bai ◽  
Nan Zhang ◽  
Huifeng Wu
Keyword(s):  
Prostate Biopsy ◽  
Transrectal Ultrasound ◽  
Urine Volume ◽  
Cancer Center ◽  
Control Group ◽  
Urinary Flow ◽  
Voiding Difficulty ◽  
Male Patients ◽  
Baseline Values

<b><i>Introduction:</i></b> The aim of this study was to investigate the association of transrectal ultrasound (TRUS)-guided prostate biopsy with voiding impairment and the efficacy of doxazosin treatment. <b><i>Methods:</i></b> A prospective observational study including 200 male patients undergoing TRUS-guided prostate biopsy was performed between May 2020 and December 2020. One hundred patients underwent biopsy with doxazosin (doxazosin group). The remaining 100 patients underwent biopsy without doxazosin (control group). All patients were questioned regarding post-biopsy voiding difficulty and acute urinary retention. The International Prostate Symptom Score (IPSS), maximal urinary flow rate (Q<sub>max</sub>), and residual urine volume were recorded before biopsy and at 7 and 30 days after biopsy. <b><i>Results:</i></b> There were no significant differences in baseline parameters between the two groups. The rate of post-biopsy voiding difficulty in the doxazosin group was significantly lower than that in the control group. Compared with baseline values, doxazosin treatment significantly improved IPSS, quality of life scores, and Q<sub>max</sub> after biopsy (<i>p</i> &#x3c; 0.05). The baseline values of IPSS and prostate size may be risk factors for post-biopsy voiding difficulty. <b><i>Conclusion:</i></b> TRUS-guided prostate biopsy causes transient voiding impairments, which may be improved by doxazosin treatment.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction

2021 ◽  
Author(s):  
Nicholas T. Haddock ◽  
Ricardo Garza ◽  
Carolyn E. Boyle ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Patient Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Compliance Rate ◽  
Fluid Management ◽  
Control Group ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Eras Protocol

Abstract Background The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. Methods This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Results Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. Conclusion The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

POTENTIAL DIURETIC EFFECT OF CURCUMA AMADA ROXB. RHIZOME EXTRACTS

INDIAN DRUGS ◽  
2013 ◽  
Vol 50 (04) ◽  
pp. 34-38
Author(s):  
P Bommannavar ◽  
◽  
K. Patil
Keyword(s):  
Aqueous Extract ◽  
Urine Volume ◽  
Control Group ◽  
Aqueous Extracts ◽  
Diuretic Activity ◽  
Curcuma Amada ◽  
Male Wistar Rats ◽  
Total Urine ◽  
Dose Dependent Increase ◽  
Dose Dependent

The present study was undertaken to establish the diuretic activity of alcoholic and aqueous extract of dried rhizomes of Curcuma amada Roxb in rats. Alcoholic and aqueous extracts of rhizomes were administered to experimental male Wistar rats orally at doses of 250 and 500 mg/kg and compared with furosemide (10 mg/kg) as the reference standard. The parameters measured for diuretic activity were total urine volume, urine electrolyte concentration such as sodium, potassium and chloride have been evaluated. The rats treated with alcoholic and aqueous extract of Curcuma amada in a dose of 250 and 500 mg/kg showed higher urine output when compared to the respective control. Both alcoholic and aqueous extracts have showed a significant dose-dependent increase in the excretion of electrolytes when compared to the control group. The result indicates that alcoholic and aqueous extract is an effective natriuretic and kaliuretic diuretic, which supports the traditional claim about the Curcuma amada Roxb being used as diuretics.

scholarly journals Dual Targeting of Cancer Cells and MMPs with Self-Assembly Hybrid Nanoparticles for Combination Therapy in Combating Cancer

Pharmaceutics ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 1990
Author(s):  
Kai Zhang ◽  
Jingjing Li ◽  
Xiaofei Xin ◽  
Xiaoqing Du ◽  
Di Zhao ◽  
...  
Keyword(s):  
T Cells ◽  
Cancer Cells ◽  
Self Assembly ◽  
Chemotherapeutic Agents ◽  
Hybrid Nanoparticles ◽  
Control Group ◽  
Hyperthermia Treatment ◽  
Immune Modulators ◽  
Dual Targeting

The co-delivery of chemotherapeutic agents and immune modulators to their targets remains to be a great challenge for nanocarriers. Here, we developed a hybrid thermosensitive nanoparticle (TMNP) which could co-deliver paclitaxel-loaded transferrin (PTX@TF) and marimastat-loaded thermosensitive liposomes (MMST/LTSLs) for the dual targeting of cancer cells and the microenvironment. TMNPs could rapidly release the two payloads triggered by the hyperthermia treatment at the site of tumor. The released PTX@TF entered cancer cells via transferrin-receptor-mediated endocytosis and inhibited the survival of tumor cells. MMST was intelligently employed as an immunomodulator to improve immunotherapy by inhibiting matrix metalloproteinases to reduce chemokine degradation and recruit T cells. The TMNPs promoted the tumor infiltration of CD3+ T cells by 2-fold, including memory/effector CD8+ T cells (4.2-fold) and CD4+ (1.7-fold), but not regulatory T cells. Our in vivo anti-tumor experiment suggested that TMNPs possessed the highest tumor growth inhibitory rate (80.86%) compared with the control group. We demonstrated that the nanoplatform could effectively inhibit the growth of tumors and enhance T cell recruitment through the co-delivery of paclitaxel and marimastat, which could be a promising strategy for the combination of chemotherapy and immunotherapy for cancer treatment.

scholarly journals Hepato & nephro protective effects of naringenin-loaded tpgs polymeric nanosuspension against cisplatin-induced toxicity

2019 ◽  
Vol 10 (4) ◽  
pp. 2755-2764
Author(s):  
Sumathi Rajamani ◽  
Gobinath Kalyanasundaram ◽  
Tamizharasi Sengodan ◽  
Sivakumar Thangavelu ◽  
Nikhitha K Shanmukhan ◽  
...  
Keyword(s):  
Antioxidant Activities ◽  
Aqueous Solubility ◽  
Protective Role ◽  
Chemotherapeutic Agents ◽  
Glycol Succinate ◽  
High Pressure Homogenization ◽  
Protective Effects ◽  
Male Wistar Rats ◽  
Nephroprotective Effect

Cisplatin (Cis-Diammineplatinum (II) dichloride/CIS) is one of the most potent chemotherapeutic agents widely used in treatment of various cancers. Naringenin (NAR), a natural flavonoid, protect against CIS-induced injury in rats without hampering CIS beneficial cytotoxic activity. Even though NAR exhibits therapeutic potency, clinical evolution of the molecule is embarrassed because of very less aqueous solubility which corresponds to low availability at the site of the tumor. In our former analysis, nanosuspension of naringenin (NARNS) was developed by the method of high-pressure homogenization. The study had been continued to evaluate the protective role of D-α-Tocopheryl polyethylene glycol succinate (TPGS) coated NARNS, against oxidative stress-induced hepato and nephrotoxicity in male Wistar rats upon CIS treatment. Induction of acute hepato and neprotoxicity was done by intraperitoneal injection (i.p) injection of CIS (7 mg/kg of body weight) and administration of NAR and NARNS. Administration of NARNS virtually suppressed CIS-induced and liver injury evidenced by a reduction of lipid peroxidation level, blood urea nitrogen, serum uric acid, creatinine and elevated enzymatic antioxidant activities of superoxide dismutase, catalase, and glutathione peroxidase in rats liver tissue. Histological studies substantiated the biochemical parameters. The study suggests that NARNS has strong hepato and nephroprotective effect compared to NAR.

scholarly journals SENSITIVITY OF S+ERUM PROTEINS OF GI CANCER PATIENTS TO CHEMOTHERAPY COURSES

2020 ◽  
Vol 52 (01) ◽  
pp. 34-34
Author(s):  
Irine Ioramashvili ◽  
Rusudan Sujashvili ◽  
Marika Gamkrelidze ◽  
Sofia Tsitsilashvili
Keyword(s):  
Human Rights ◽  
Cancer Patients ◽  
Bacterial Infections ◽  
Serum Proteins ◽  
Protein Composition ◽  
Chemotherapeutic Agents ◽  
Vulnerable Groups ◽  
Control Group ◽  
World Population ◽  
Gi Cancer

Gastrointestinal cancers (GI) are one of the most abundant types of cancers among the world population, though statistical data indicate that in eastern Asia these types of cancer occur 4 times more often than in Western Europe. Absence of treatment of bacterial infections, obesity, and lack of vegetable food in a diet can be the case of GI cancer. All pathologies are inevitably connected to the changes in cell cycle, abnormal protein amount and their dysfunction. Serum proteins are widely used as an additional source of information about body condition, also changes in protein composition can point out the mechanism of disease development and effectiveness of treatment. In the presented work we studied protein composition of GI cancer patients in different stages of cancer development, after and before chemotherapy and compared these data to protein composition of healthy control group of voluntaries. Treatment of patients was performed according the guidelines appropriate for the GI cancer. Association of the effectiveness of treatment at the different stages of chemotherapeutic courses and changes of protein composition of blood serum has been assessed. Proteins composition was studies by SDS-PAGE electrophoresis and densitometry analysis. Experimentally gained molecular and statistical information exposed the most vulnerable groups of proteins affected by chemotherapeutic agents indicating targets for searching new biomarkers for treatment effectiveness. Research involving human patients performed in accordance with the requirements of the Council of Europe Convention on Human Rights and Biomedicine, Biomedical Research, as well as the UNESCO Declaration of Bioethics and Human Rights.

PLETH VARIABILITY INDEX-GUIDED FLUID THERAPY LOWERS POST-OPERATIVE LACTATE LEVELS IN DOGS UNDERGOING ELECTIVE ABDOMINAL SURGERY: A RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 44 (01) ◽  
pp. 7-14
Author(s):  
Chun-Hsiang Hu ◽  
Tien-Huan Hsu ◽  
Kuan-Sheng Chen ◽  
Wei-Ming Lee ◽  
Hsien-Chi Wang
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Fluid Management ◽  
Tissue Perfusion ◽  
Control Group ◽  
Pleth Variability Index ◽  
Elective Abdominal Surgery ◽  
Variability Index ◽  
Lactate Levels

To evaluate the hemodynamic optimization effect of pleth variability index (PVI)-guided fluid therapy during abdominal surgery on tissue perfusion, 19 client-owned dogs that underwent elective abdominal surgery were randomized into control ([Formula: see text]) and PVI ([Formula: see text]) groups. In the control group, perioperative fluid management was based on the 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats. In the PVI group, the fluid rate was maintained based on basic daily requirements. If PVI was higher than 15% for [Formula: see text][Formula: see text]min, 3–5[Formula: see text]mL/kg of crystalloid fluid bolus was infused. The tissue perfusion indicator, lactate levels, was measured at the time of intubation, extubation, and 6, 12 and 24[Formula: see text]h postoperatively. There were no significant differences in total and average fluid infused between control and PVI groups. The control group had significantly higher lactate levels than that of the PVI group at 12[Formula: see text]h postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]) and overall postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]). The control group revealed more profound hemodilution, as indicated by significantly decreased postoperative blood urea nitrogen (BUN), creatinine, and total protein. PVI-guided fluid therapy lowers lactate levels after elective abdominal surgery in dogs. Therefore, based on the result of this study PVI may provide customized fluid therapy to improve tissue perfusion and avoid unnecessary fluid overload.

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