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Reduction of oxidative stress a key for enhanced postoperative recovery with fewer complications in esophageal surgery patients: Randomized control trial to investigate therapeutic impact of anesthesia management and usefulness of simple blood test for prediction of high-risk patients.
Tsuchiya, M, Shiomoto, K, Mizutani, K, Fujioka, K, Suehiro, K, Yamada, T, Sato, EF, Nishikawa, K
Medicine. 2018;(47):e12845
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Abstract
BACKGROUND Oxidative stress may be an integral determinant of surgical stress severity. We examined whether the preoperative level of derivatives of reactive oxygen metabolites (d-ROMs), an oxidative stress biomarker based on total hydroperoxides in circulating blood, is predictive of increased risk of delayed recovery and complications after surgery, as well as the effects of anesthesia management on postoperative recovery in light of oxidative stress. METHODS Patients (American Society of Anesthesiologists physical status I-II) scheduled for a radical esophagectomy (n = 186) were randomly selected to receive inhalational sevoflurane (n = 94) or intravenous propofol (n = 92) anesthesia. Preoperative blood d-ROMs level, as well as pre-and postoperative plasma ferric-reducing ability, were analyzed to assess oxidative stress, with white blood cell (WBC) count, C-reactive protein (CRP) level, incidence of severe postoperative complications, and postoperative recovery process within 30 days after surgery also examined in a double-blind fashion. RESULTS Postoperative normalization of WBC and CRP was extended in patients with elevated preoperative d-ROMs [WBC versus d-ROMs: correlation coefficient (r) = 0.58 P < .001; CRP versus d-ROMs: r = 0.46 P < .001]. Receiver operating characteristics analysis of d-ROMs in relation to incidence of severe postoperative complications revealed an optimum d-ROMs threshold value of 410 UCarr and that patients with ≥410 UCarr had a greater risk of complications as compared to those with lower values (odds ratio = 4.7). Plasma ferric-reducing ability was decreased by 61 ± 185 mmol·l (P < .001) after surgery, demonstrating development of surgery-related oxidative stress, the magnitude of which was positively correlated with preoperative d-ROMs level (r = 0.16, P = .043). A comparison of the 2 anesthesia management protocols showed that patients who received propofol, an antioxidant anesthetic, had no postoperative decrease in ferric-reducing ability, lower incidence of severe postoperative complications (7 of 92 versus 18 of 94, P = .030, odds ratio = 0.35), and faster uneventful recovery time (WBC normalization days 7.1 ± 5.2 versus 13.6 ± 10.2, P < .001) as compared to those who received sevoflurane. CONCLUSIONS Elevated preoperative blood d-ROMs predicts greater intraoperative oxidative stress and increased postoperative complications with prolonged recovery, thus is useful for identifying high-risk patients for delayed and complicated surgical recovery. Reduction of oxidative stress is vital for enhanced recovery, with control by antioxidants such as propofol a possible solution.
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Blood pressure lowering and anti-inflammatory effects of hesperidin in type 2 diabetes; a randomized double-blind controlled clinical trial.
Homayouni, F, Haidari, F, Hedayati, M, Zakerkish, M, Ahmadi, K
Phytotherapy research : PTR. 2018;(6):1073-1079
Abstract
Elevated levels of reactive oxygen species under diabetic condition lead to vascular complications and inflammation. This study aimed to examine the effects of hesperidin supplement on blood pressure and inflammatory markers in type 2 diabetes. In this research, 64 patients were randomly allocated to receive 500 mg/day hesperidin or placebo capsules for 6 weeks. Data on systolic blood pressure (SBP), diastolic blood pressure, serum total antioxidant capacity (TAC), tumor necrosis factor alpha, interleukin 6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were collected at the baseline and at the end of the study. In the hesperidin group, SBP (122.7 ± 8.5 vs. 119.0 ± 7.4; p = .005), mean arterial blood pressure (94.2 ± 5.5 vs. 91.8 ± 5.5; p = .009), IL-6 (8.3 ± 2.1 vs. 7.4 ± 1.8; p = .001), and hs-CRP (1.9 ± 1.2 vs. 1.1 ± 0.9; p < .000) decreased whereas TAC increased (0.74 ± 0.1 vs. 0.82 ± 0.1; p < .000) in comparison to the baseline values. There was a significant difference in mean percent change of SBP, diastolic blood pressure, mean arterial blood pressure, serum TAC, and inflammatory markers (tumor necrosis factor alpha, IL-6, and hs-CRP) between hesperidin and control groups following intervention in adjusted models (p < .05). These results suggest that hesperidin may have antihypertensive and anti-inflammatory effects in type 2 diabetes.
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Characterization of the Cicatrization Process in Diabetic Foot Ulcers Based on the Production of Reactive Oxygen Species.
López-Delis, A, de S Rodrigues Fleury Rosa, S, de Souza, PEN, Carneiro, MLB, Rosa, MFF, Macedo, YCL, Veiga-Souza, FH, da Rocha, AF
Journal of diabetes research. 2018;:4641364
Abstract
The present study aims at evaluating the correlation between the free radical formation and the healing action of lower limbs' ulcers in a randomized controlled trial with the use of an adhesive derived from natural latex associated with a light-emitting diode (LED) circuit. The sample consists of 15 participants with lower limb lesions divided into three groups: group 1 case (5 participants) received the proposed dressing system adhesive of the natural latex associated with the LED circuit; group 2 control (5 participants) received the dressings at home performed by nurses according to and established by the clinic of wounds (treated with calcium alginate or silver foam); and group 3 (5 participants) also received the dressing in their homes with the use of the dressing adhesive derived from the natural latex associated with the LED circuit. The collected data were analyzed qualitatively and quantitatively by electron paramagnetic resonance for determination of free radical formation. Kruskal-Wallis statistical test was used to evaluate the effect of treatment on the lower limb's ulcer cicatrization process and its correlation with free radical. The results obtained corroborated the hypothesis about the reduction of the quantity of these molecules in the end of treatment related to the healing wound.
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Effect of High-Dose Allopurinol Pretreatment on Cardiac Biomarkers of Patients Undergoing Elective Percutaneous Coronary Intervention: A Randomized Clinical Trial.
Alemzadeh-Ansari, MJ, Hosseini, SK, Talasaz, AH, Mohammadi, M, Tokaldani, ML, Jalali, A, Pourhosseini, H
American journal of therapeutics. 2017;(6):e723-e729
Abstract
BACKGROUND Increased accumulation of reactive oxygen species contributes to pathophysiologic states such as endothelial dysfunction, metabolic and functional impairment, inflammatory activation, and other features of cardiovascular pathophysiology. Allopurinol acts as a xanthine oxidase inhibitor that reduces the amount of free radicals after reactive oxygen species generation. METHODS AND RESULTS In this placebo-controlled randomized clinical trial, all patients admitted with coronary artery disease who are candidates for elective percutaneous coronary intervention (PCI) were included. The 254 patients were randomly divided into 2 groups. Blood samples for cardiac biomarkers (creatine kinase [CK]-MB and troponin T [cTnT]) were collected from all patients after admission (the day before PCI), and also 8 and 16 hours after intervention. In group 1 (133 patients), 600 mg allopurinol was orally administered on the day before PCI, and another same dose on the day of PCI, and the elective PCI was performed. In group 2 (121 patients), elective PCI was performed without pretreatment with allopurinol. In an unadjusted model, the serum levels of both CK-MB and cTnT, 16 hours after PCI were higher in the placebo group as compared with the allopurinol group, although it was statistically insignificant. We compared the maximum levels of CK-MB and cTnT (8 or 16 hours after PCI) and their maximum changes in both groups. After adjustment for confounders, use of allopurinol did not have any statistically significant association with the rise of cardiac-spec-fic enzymes. CONCLUSIONS Allopurinol could not be effective significantly, in patients undergoing elective PCI, to decrease cardiac-specific enzymes, and seems not to be of use before PCI.
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The effect of electro-acupuncture on pro-oxidant antioxidant balance values in overweight and obese subjects: a randomized controlled trial study.
Mazidi, M, Abbasi-Parizad, P, Abdi, H, Zhao, B, Rahsepar, AA, Tavallaie, S, Parizadeh, SM, Rezaie, P, Safariyan, M, Nematy, M, et al
Journal of complementary & integrative medicine. 2017;(2)
Abstract
Objective To undertake a randomized controlled trial in 196 obese subjects to examine the effect of electro-acupuncture on serum pro-oxidant antioxidant balance (PAB) values. Methods Subjects received authentic acupuncture (cases) or sham acupuncture (controls) for 6 weeks in combination with a low-calorie diet. In the following 6 weeks, they received the low-calorie diet alone. Serum PAB was measured at baseline, and 6 and 12 weeks later. Results We found that serum PAB values decreased significantly in the group receiving the authentic acupuncture compared to the sham treatment (p<0.001) at week 6, and whilst serum PAB increased significantly (p<0.05) in the second phase of the study, a significant difference between two groups remained at 12 weeks (p<0.05). Conclusions Electro-acupuncture in combination with a low-calorie diet was more effective at reducing serum PAB values in obese subjects compared to diet alone. Further work is required to determine the mechanism by which electro-acupuncture has this effect.
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The Effects of Curcumin and Curcumin-Phospholipid Complex on the Serum Pro-oxidant-Antioxidant Balance in Subjects with Metabolic Syndrome.
Ghazimoradi, M, Saberi-Karimian, M, Mohammadi, F, Sahebkar, A, Tavallaie, S, Safarian, H, Ferns, GA, Ghayour-Mobarhan, M, Moohebati, M, Esmaeili, H, et al
Phytotherapy research : PTR. 2017;(11):1715-1721
Abstract
Metabolic syndrome (MetS) is defined by a clustering of metabolic and anthropometric abnormalities and is associated by an increased risk of cardiovascular disease. We have investigated the effect of curcumin supplementation on the serum pro-oxidant-antioxidant balance (PAB) in patients with MetS. This double-blind, randomized, placebo-controlled trial was conducted over 6 weeks. Subjects (n = 120) were randomly allocated to one of three groups (curcumin, phospholipidated curcumin, and placebo). The curcumin group received 1 g/day of simple curcumin, the phospholipidated curcumin group received 1 g/day of phospholipidated curcumin (containing 200 mg of pure curcumin), and the control group received 1 g/day of placebo. Serum PAB was measured before and after the intervention (at baseline and at 6 weeks). Data analyses were performed using spss software (version 16.0). Serum PAB increased significantly in the curcumin group (p < 0.001), but in the phospholipidated curcumin group, elevation of PAB level was not significant (p = 0.053). The results of our study did not suggest any improvement of PAB following supplementation with curcumin in MetS subjects. Copyright © 2017 John Wiley & Sons, Ltd.
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Effects of Radio Frequency and Ultrasound Cavitation Therapy on Serum C-reactive Protein and Pro-oxidant-Antioxidant Levels.
Mohammadzadeh, M, Nasrfard, S, Nezafati, P, Arabpour, M, Ghaane, N, Salehi, M, Safarian, M, Ghayour-Mobarhan, M, Ferns, GA, Norouzy, A
Archives of Iranian medicine. 2016;(5):348-52
Abstract
BACKGROUND A combination of radio-frequency (RF) and ultrasound cavitation (UC) has been reported to reduce indices of obesity. In this study, we aimed to investigate the effect of a combination of these techniques on anthropometric indices, pro-oxidant-antioxidant balance (PAB), and serum high-sensitivity C-reactive protein (hs-CRP). MATERIALS AND METHODS This randomized clinical trial was performed on 50 healthy women between January 2014 and June 2014 in Ghaem Hospital, Mashhad, Iran. Participants were randomized to one of two groups, both of which received a low-calorie diet containing 500-kcal energy deficit per day. The trial group included twenty-five subjects who were assigned to the combined treatment of RF and ultrasound cavitation program of abdomen and flank areas. There were twenty-five control subjects who received the low calorie diet alone. Biochemical markers, including serum hs-CRP and PAB values, and anthropometric indices were measured in the intervention group and healthy controls. RESULTS For both the intervention and control groups, waist circumference was reduced significantly by 3.76 ± 1.69 and 2.40 ± 1.04, respectively (P < 0.05). In addition, abdominal circumference was reduced by 9.5 ± 2.66 and 3.12 ± 1.88, in these groups, respectively (P < 0.001). Decrement of PAB level in the intervention group, and its increment in the control group, were not significant (P > 0.05). In addition, reductions of hs-CRP and PAB between the two studied groups during five weeks of study were not significant (P > 0.05). CONCLUSION Although there were significant reductions in anthropometric indices following treatment with RF and UC, the effects on serum PAB or hs-CRP were no significantly different, compared to the control group. Further studies are needed to confirm the beneficial effect for the use of these techniques.
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Resistance exercise training and in vitro skeletal muscle oxidative capacity in older adults.
Flack, KD, Davy, BM, DeBerardinis, M, Boutagy, NE, McMillan, RP, Hulver, MW, Frisard, MI, Anderson, AS, Savla, J, Davy, KP
Physiological reports. 2016;(13)
Abstract
Whether resistance exercise training (RET) improves skeletal muscle substrate oxidative capacity and reduces mitochondrial production of reactive oxygen species in older adults remains unclear. To address this, 19 older males (≥60 years) were randomized to a RET (n = 11) or to a waitlist control group (n = 8) that remained sedentary for 12 weeks. RET was comprised of three upper body and four lower body movements on resistance machines. One set of 8-12 repetitions to failure of each movement was performed on three nonconsecutive days/week. Improvements in chest press and leg press strength were assessed using a three-repetition maximum (3 RM). Body composition was assessed via dual energy X-ray absorptiometry. Muscle biopsies were obtained from the vastus lateralis muscle at baseline and at both 3 weeks and 12 weeks. Palmitate and pyruvate oxidation rates were measured from the (14)CO2 produced from [1-(14)C] palmitic acid and [U-(14)C] pyruvate, respectively, during incubation of muscle homogenates. PGC-1α, TFAM, and PPARδ levels were quantified using qRT-PCR Citrate synthase (CS) and β-HAD activities were determined spectrophotometrically. Mitochondrial production of reactive oxygen species (ROS) were assessed using the Amplex Red Hydrogen Peroxide/Peroxidase assay. There were no significant changes in body weight or body composition following the intervention. Chest press and leg press strength (3RM) increased ~34% (both P < 0.01) with RET There were no significant changes in pyruvate or fatty acid oxidation or in the expression of target genes with the intervention. There was a modest increase (P < 0.05) in βHAD activity with RET at 12 weeks but the change in CS enzyme activity was not significant. In addition, there were no significant changes in ROS production in either group following RET Taken together, the findings of this study suggest that 12 weeks of low volume RET does not increase skeletal muscle oxidative capacity or reduce ROS production in older adults.
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Relationship between the Peroxidation of Leukocytes Index Ratio and the Improvement of Postprandial Metabolic Stress by a Functional Food.
Peluso, I, Manafikhi, H, Reggi, R, Longhitano, Y, Zanza, C, Palmery, M
Oxidative medicine and cellular longevity. 2016;:5630985
Abstract
For the first time, we investigated the relationship between postprandial dysmetabolism and the Peroxidation of Leukocytes Index Ratio (PLIR), a test that measures the resistance of leukocytes to exogenous oxidative stress and their functional capacity of oxidative burst upon activation. Following a blind, placebo controlled, randomized, crossover design, ten healthy subjects ingested, in two different occasions, a high fat and high carbohydrates meal with Snello cookie (HFHCM-S) or with control cookies (HFHCM-C). Snello cookie, a functional food covered by dark chocolate and containing glucomannan, inulin, fructooligosaccharides, and Bacillus coagulans strain GanedenBC30, significantly improved postprandial metabolic stress (insulin, glucose, and triglycerides) and reduced the postprandial increase of uric acid. HFHCM-S improved PLIR of lymphocytes, but not of monocytes and granulocytes. Both meals increased granulocytes' count and reduced the lipoperoxidation induced by both exogenous free radicals and reactive oxygen species (ROS) produced by oxidative burst. Our results suggest that the healthy status of the subjects could be a limitation of this pilot study for PLIR evaluation on cells that produce ROS by oxidative burst. In conclusion, the relationship between PLIR and postprandial dysmetabolism requires further investigations.
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Circulating levels of reactive oxygen species in patients with nonproliferative diabetic retinopathy and the influence of antioxidant supplementation: 6-month follow-up.
Domanico, D, Fragiotta, S, Cutini, A, Carnevale, C, Zompatori, L, Vingolo, EM
Indian journal of ophthalmology. 2015;(1):9-14
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Abstract
AIMS: The aim was to evaluate circulating levels of reactive oxygen species (ROS) and changes in central macular thickness (CMT) in patients with nonproliferative diabetic retinopathy (NPDR) after antioxidant supplementation. MATERIALS AND METHODS A total of 68 patients (68 eyes) with NPDR were enrolled. Patients were randomly divided into two groups: Treated with antioxidant supplement (Group A) and untreated control group (Group B). Each tablet, for oral administration, containing pycnogenol 50 mg, Vitamin E 30 mg and coenzyme Q10 20 mg. CMT and free oxygen radical test (FORT) were analyzed at baseline (T0), 3 (T1) and 6 (T2) months in both groups. RESULTS In Group A, FORT levels and CMT were significantly reduced over time (P < 0.001 for both). In Group B, FORT levels were increased (P < 0.001) and CMT did not vary significantly (P = 0.81) over 3 time points. CONCLUSIONS This is the first study showing the reduction of ROS levels in patients with NPDR thanks to antioxidant therapy. Moreover, our findings have suggested also an influence on retinal thickness.