-
1.
Volume of intraoperative normal saline versus lactated Ringer's solution on acute kidney injury: A secondary analysis of the SOLAR trial.
Marquez, L, Medellin, S, Wang, L, Maheshwari, K, Shaw, A, Sessler, DI
Journal of clinical anesthesia. 2025;:111744
Abstract
UNLABELLED Postoperative acute kidney injury (AKI) is common after non-cardiac surgery. Normal saline and lactated Ringer's solution are both used for volume replacement during surgery. Normal saline decreases renal blood flow and causes hyperchloremic acidosis whereas lactated Ringer's does not. The incidence of AKI is similar with modest volumes of each fluid. But it remains unclear whether larger volumes of normal saline provoke AKI. OBJECTIVE Evaluate whether intraoperative crystalloid volume modifies the relationship between the AKI risk and treatment group. DESIGN Secondary analysis of a single-center multiple cross-over cluster trial. SETTING Intraoperative care. PATIENTS We enrolled 8616 adults who had colorectal or orthopedic surgery at a large academic institution. INTERVENTIONS Clusters of patients were alternately assigned to intraoperative normal saline or lactated Ringer's solution. MEASUREMENTS The primary outcome was the incidence of acute kidney injury (AKI) as a function of intraoperative crystalloid volume (0-1, 1-2, 3-4, or 4+ liters) and the type of crystalloid. Our secondary outcome was the change in postoperative serum chloride concentration during the first 24 h. MAIN RESULTS The risk of AKI did not differ significantly in patients given 0-1, 1-2, or 3-4 L saline or lactated Ringers solutions. In contrast, patients given 2-3 or > 4 L of lactated Ringer's solution had a higher risk of AKI than those given saline. Patients assigned to normal saline had progressively greater plasma chloride concentrations than those given lactated Ringer's across all volume categories. CONCLUSIONS While saline administration clearly causes volume-dependent hyperchloremia, we found no evidence to support the theory that large volumes of saline provoke AKI. Therefore, either fluid seems reasonable for intraoperative use.
-
2.
Comparative evaluation of calretinin immunohistochemical expression in calcifying odontogenic cyst and ameloblastoma.
Mahdizadeh, M, Mahdavi, N, Bijani, A, Bijani, F
BMC oral health. 2025;(1):158
Abstract
BACKGROUND Calretinin is a 29 kilodalton (KDa) calcium-binding protein that is expressed in normal and tumoral tissues. The expression of calretinin has been shown in the dental epithelium during odontogenesis and in different odontogenic cysts and tumors such as ameloblastoma. Since the epithelium of calcifying odontogenic cyst (COC) is similar to ameloblastoma and in both lesions, an arrangement of loose cells similar to stellate reticulum is seen, we aimed to investigate the comparative expression of calretinin in COC and ameloblastoma. METHODS In this observational-analytical study, 11 paraffin blocks of each lesion were examined. The immunohistochemical expression of calretinin and its severity and distribution were evaluated. Data were evaluated using SPSS version 26 and P < 0.05 was considered the level of significance. RESULTS Out of 11 ameloblastoma samples, calretinin staining was positive in 6 samples in the stellate reticulum-like cells and also in the lining of microcysts and macrocysts in some cases. Ameloblast like cells did not show staining. In COC samples, epithelial cells were not stained, but in 8 samples, staining was seen in the area of ghost cells. There was no significant difference in staining between ameloblastoma and COC (P = 0.33), but the difference in staining in the stellate reticulum of ameloblastoma and COC was significant. (P = 0.012). CONCLUSIONS it is concluded that calretinin does not play a role in the pathogenesis and histogenesis of COC epithelium, but since ghost cells are caused by a degenerative process, the possibility of involving calretinin as an apoptotic factor in the formation of these cells is supported.
-
3.
Optical coherence tomography (OCT) and OCT-angiography in syndromic versus non-syndromic USH2A-associated retinopathy.
Antropoli, A, Arrigo, A, Caprara, C, Bianco, L, Mercuri, S, Berni, A, Passerini, I, Gambarotta, S, Sodi, A, Bandello, F, et al
European journal of ophthalmology. 2025;(1):106-111
Abstract
PURPOSE To compare non-syndromic and syndromic forms of USH2A-related retinitis pigmentosa (RP) by means of structural optical coherence tomography (OCT) and OCT-angiography (OCTA). METHODS Observational, cross-sectional, multicenter study. All patients underwent best corrected visual acuity (BCVA) measurement, OCT (Spectralis HRA + OCT, Heidelberg Engineering) and OCTA (OCT DRI Topcon Triton, Topcon Corporation). We compared subfoveal choroidal thickness (SCT), choroidal vascularity index (CVI), presence of cystroid macular edema (CME), macular vessel density (VD) at the superficial and deep capillary plexa, as well as VD of the radial peripapillary capillary (RPC) network, between syndromic and non-syndromic patients with USH2A-associated retinopathy. RESULTS Thirty-four eyes from 18 patients (7 females) were included. Thirteen patients (72.2%) were affected by Usher syndrome type 2, whereas the remaining 5 subjects (27.8%) had non-syndromic retinitis pigmentosa (nsRP). Syndromic patients were younger than nsRP (p = 0.01) and had a worse visual acuity than those with the exclusively retinal phenotype. Patients with Usher syndrome type 2 had a higher prevalence of CME and a thicker choroid compared to nsRP, although these results were not statistically significant (p = 0.775 and p = 0.122, respectively). Similarly, none of the other quantitative OCT and OCTA parameters was statistically different between the two groups. CONCLUSIONS Despite their younger age, patients with Usher syndrome type 2 displayed similar choroidal and microvascular changes compared to those with nsRP.
-
4.
Low versus high initial oral glucocorticoid dose for lupus nephritis: a pooled analysis of randomised controlled clinical trials.
Saxena, A, Sorrento, C, Izmirly, P, Sullivan, J, Gamez-Perez, M, Law, J, Belmont, HM, Buyon, JP
Lupus science & medicine. 2025;(1)
Abstract
OBJECTIVE Traditional initial treatment regimens for lupus nephritis (LN) used oral glucocorticoids (GC) in starting doses up to 1.0 mg/kg/day prednisone equivalent with or without a preceding intravenous methylprednisolone pulse. More recent management guidelines recommend lower starting oral GC doses following intravenous pulse therapy. As there have been no large studies directly comparing patients receiving low versus high initial oral GC doses, this pooled analysis of high-quality randomised controlled trials (RCTs) aims to evaluate differences in efficacy and safety. METHODS Published data were analysed from RCTs that assessed variable GC doses in the standard of care (SOC) treatment arms. Patients receiving starting prednisone doses up to 0.5 mg/kg/day (low dose) were compared with 1.0 mg/kg/day (high dose). Complete renal response requiring urine protein-creatinine ratio <0.5 mg/mg (CRR 0.5), CRR or partial renal response (PRR), serious adverse events (SAE) and SAE due to infections at 12 months of treatment were compared between groups. RESULTS 417 patients from SOC arms of five studies were exposed to low-dose initial GC after intravenous pulse, while 521 patients from four studies were treated with high-dose oral GC. In patients with low-dose oral GC, 25.2% achieved CRR 0.5 at 12 months compared with 27.2% in high-dose groups, p=0.54. CRR or PRR was attained in 48.7% low-dose vs 43.6% high-dose patients, p=0.14. SAEs and infection SAEs were less common in the low-dose GC group (19.4% vs 31.6%, p<0.001 and 9.8% vs 16.5%, p=0.012, respectively). CONCLUSIONS Based on pooled RCT data, there was no significant difference in 12-month renal responses between patients receiving low-dose prednisone following intravenous GC compared with those receiving initial high doses. SAEs were less frequent in patients receiving low-dose initial GC. These findings support the use of lower oral GC doses in LN treatment.
-
5.
Comparison of Ziziphus jujube Mill. Syrup versus polyethylene glycol in children with functional constipation: a randomized clinical trial.
Keihanian, F, Maleknejad, S, Saeidinia, A, Soltanipour, S, Pirooz, A
Scientific reports. 2025;(1):1674
Abstract
Functional constipation is a common disorder of the gastrointestinal tract in children without specific treatment. Ziziphus jujuba has been used in traditional medicine for various diseases such as constipation. A safe and inexpensive treatment with few side effects can be used as an effective alternative to current medications. In this study, we sought to compare Ziziphus jujuba syrup (ZS) with polyethylene glycol (PEG) for the treatment of pediatric functional constipation. A double-blind, randomized clinical trial was performed on children aged 2-10 years with functional constipation who were referred to the gastroenterology clinic of the 17-Shahrivar Hospital in Rasht, Iran. Eligible patients were randomized into two groups: PEG group; 1-5 cc/kg/day (40% w/v solution without electrolytes; average dose: 0.2-1 g/kg), and ZS group; 1-5 cc/kg/day (average dose: 5-25 mg/kg). All patients were followed up for three months, every 2 weeks in the first month, and then monthly for 2 months. At the beginning and end of the study, liver and kidney function tests and blood sugar levels were checked. Data were analyzed using SPSS software version 19 at a significance level of 0.05. Out of 90 eligible children, 32 patients in the PEG group and 30 patients in the ZS group completed the follow-up visits. The mean age of the subjects was 4.31 ± 1.97 years. There was no significant difference between the two groups in terms of age (P = 0.181), gender (P = 0.218), age at onset of constipation (P = 0.083), and weight (P = 0.199). The average therapeutic response score in the ZS group improved prominently compared to the PEG group (P < 0.05). The average number of encopresis and visual analog scale pain scores significantly decreased in the ZS group compared to the PEG group (P < 0.05). Other indices, including frequency of defecation, and medication adherence in the ZS group were significantly improved compared to the PEG group (P < 0.05). Only in the PEG group, a few cases reported self-limiting side effects. ZS can be a treatment choice for functional constipation without any adverse events or liver or kidney injury in children. However, further studies are necessary to find potential side effects.
-
6.
Probiotics for adults with major depressive disorder compared with antidepressants: a systematic review and network meta-analysis.
Zhao, S, Liang, S, Tao, J, Peng, Y, Chen, S, Wai, HKF, Chung, FY, Sin, ZY, Wong, MKL, Haqq, AM, et al
Nutrition reviews. 2025;(1):72-82
Abstract
CONTEXT Despite recent advances in antidepressants in treating major depression (MDD), their usage is marred by adverse effects and social stigmas. Probiotics may be an efficacious adjunct or standalone treatment, potentially circumventing the aforementioned issues with antidepressants. However, there is a lack of head-to-head clinical trials between these 2 interventions. OBJECTIVE A systematic review and network meta-analysis was conducted to compare the efficacy and acceptability of these 2 interventions in treating MDD. DATA SOURCES Six databases and registry platforms for the clinical trial were systematically searched to identify the eligible double-blinded, randomized controlled trials published between 2015 and 2022. DATA EXACTION Two authors selected independently the placebo-controlled trials of antidepressants and microbiota-targeted interventions (prebiotics, probiotics, and synbiotics) used for the treatment of MDD in adults (≥18 years old). Standardized mean differences (SMDs) of depressive symptom scores from individual trials were pooled for network meta-analysis (PROSPERO no. CRD42020222305). RESULTS Forty-two eligible trials covering 22 interventions were identified, of which 16 were found to be effective in MDD treatment and the certainty of evidence was moderate to very low. When all trials were considered, compared with placebo, SMDs of interventions ranged from -0.16 (95% credible interval: -0.30, -0.04) for venlafaxine to -0.81 (-1.06, -0.52) for escitalopram. Probiotics were superior to brexpiprazole (SMD [95% credible interval]: -0.42 [-0.68, -0.17]), cariprazine (-0.44 [-0.69, -0.24]), citalopram (-0.37 [-0.66, -0.07]), duloxetine (-0.26, [-0.51, -0.04]), desvenlafaxine (-0.38 [-0.63, -0.14]), ketamine (-0.32 [-0.66, -0.01]), venlafaxine (-0.47 [-0.73, -0.23]), vilazodone (-0.37 [-0.61, -0.12]), vortioxetine (-0.39 [-0.63, -0.15]), and placebo (-0.62 [-0.86, -0.42]), and were noninferior to other antidepressants. In addition, probiotics ranked the second highest in the treatment hierarchy after escitalopram. Long-term treatment (≥8 weeks) using probiotics showed the same tolerability as antidepressants. CONCLUSION Probiotics, compared with antidepressants and placebo, may be efficacious as an adjunct or standalone therapy for treating MDD. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020222305.
-
7.
Impact of peritoneal dialysis and hemodialysis on mortality in patients with end-stage renal disease: A systematic review and meta-analysis.
Wu, Z, Chen, F, Li, P, Zhao, M
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 2025;(1):79-88
Abstract
INTRODUCTION The mortality impact of peritoneal dialysis (PD) and hemodialysis (HD) in end-stage renal disease (ESRD) remains uncertain. METHODS A meta-analysis comparing mortality in ESRD patients on PD versus HD was conducted, including 9 studies with 7556 HD and 2651 PD patients. RESULTS No significant difference was found in all-cause mortality, cardiovascular-related mortality, or infection-related mortality between HD and PD patients. Hemoglobin, ferritin, and iron levels were similar in groups, but HD patients had higher albumin and BUN levels (p < 0.05). Regarding cardiovascular factors and bone minerals, total cholesterol and LDL levels were significantly lower, and calcium levels were significantly higher in the HD group compared with the PD group (p < 0.01). CONCLUSION Mortality does not significantly differ between HD and PD in ESRD patients, though HD is linked to higher serum albumin levels and lower levels of total cholesterol and LDL.
-
8.
Pharmacokinetics and Bioequivalence of Two Formulations of Montelukast Sodium Tablets in Healthy Chinese Volunteers Under Fasting and Fed Conditions.
Rao, X, Wu, X, Hu, J, Huang, Z
Clinical pharmacology in drug development. 2025;(2):161-166
Abstract
Montelukast sodium is a leukotriene type 1 receptor antagonist that can be used for the prophylaxis and treatment of asthma. However, the pharmacokinetics of montelukast sodium tablets (10 mg) remain unclear in healthy Chinese subjects. Here, a single-dose randomized, open-label, 2-sequence, and 2-period crossover (7-day washout period between treatments) study was performed to compare the pharmacokinetics and bioequivalence between the test products and the reference at a single dose of 10 mg among healthy Chinese subjects under fasting and fed conditions. Blood samples were collected at specified time points to analyze the plasma concentrations of montelukast by a validated liquid chromatography-tandem mass spectrometry method. The results showed that the 90% confidence interval values of the geometric mean ratio of test/reference for the maximum plasma drug concentration, area under the concentration-time curve from time 0 to the end, and area under the concentration-time curve from time 0 to infinity were within the range of 80%-125%. Moreover, both the test and reference formulations were safe and well tolerated, with no occurrence of severe adverse events. These results demonstrate that both the test montelukast sodium tablets and the reference showed similar bioequivalence, safety, and tolerability among healthy Chinese subjects under fasting and fed conditions.
-
9.
Efficacy and safety of dual renin-angiotensin system (RAS) blockade for non-elderly diabetic kidney disease patients with preserved eGFR.
Mei, M, Zeng, J, Fang, L, Xiang, S, Sun, H, Wen, C, Chai, L, Chen, X, Li, Z, Li, N, et al
International urology and nephrology. 2025;(1):187-196
Abstract
AIM: Although sodium glucose cotransporter2 inhibitor (SGLT-2I) is widely used in clinical practice, sufficient renin-angiotensin system (RAS) inhibition remains the cornerstone of diabetic kidney disease (DKD) treatment. The aim of this single-center study was to evaluate the efficacy and safety of dual RAS blockade compared with angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) monotherapy in non-elderly DKD patients with preserved eGFR (WHO Standard, < 60y). METHODS This single-center study was registered in Chinese Clinical Trial Registry (ChiCTR1900024752), and approved by the ethical committee (KY201994). In this study, we recruited non-elderly type 2 diabetes volunteers with initial diagnosis of DKD to receive dual RAS blockade or monotherapy. 150 non-elderly DKD patients with preserved eGFR were recruited. The patients were randomly divided into dual RAS blockade group and monotherapy group. The dual RAS blockade group treatment regimen was an 80 mg valsartan plus a 4 mg perindopril tert-butylamine per day. At the same time, monotherapy group patients who received the 8 mg perindopril tert-butylamine or 160 mg valsartan monotherapy. The clinical data of the three groups were compared at baseline and collected during the follow-up period of 12 months. RESULTS The baseline of patients who received dual RAS blockade was similar to that of monotherapy group. After 12 months of treatment, the median level of proteinuria in the dual RAS blockade group was significantly lower than that in the monotherapy group. There was no significant difference in the estimated glomerular filtration rate (eGFR) level, potassium, blood pressure and no serious adverse reactions. CONCLUSIONS In non-elderly DKD patients with preserved eGFR, dual RAS blockade is superior to control proteinuria, and does not increase the probability of adverse reactions such as hyperkalemia, hypotension and acute kidney injury in 12 months.
-
10.
Are Two Gliflozins Different: A Prospective Multicenter Randomized Study to Assess Effect of Remogliflozin Compared With Empagliflozin on Biomarkers of Heart Failure in Indian Patients With Type 2 Diabetes Mellitus with Chronic Heart Failure (REMIT-HF Study).
Sengupta, S, Pathiyilbalagopalan, J, Mehta, A, Sawhney, JPS, Suryavanshi, S, Jamwal, N, Kadam, D, Gowda, A, Dargad, R, Bhate, A, et al
Journal of cardiac failure. 2025;(1):158-162
Abstract
There is limited data comparing two gliflozins on their effect on biomarkers in diabetic patients with chronic heart failure. A prospective, multicenter, active controlled, double-arm, investigator-initiated, interventional study enrolled 250 adults with type 2 diabetes mellitus (T2DM) and comorbid congestive heart failure (CHF; left ventricular ejection fraction [LVEF] <40%; N-terminal pro-B-type natriuretic peptide [NT-proBNP] >600 pg/mL). A total of 125 patients were allocated each to a remogliflozin (R) and empagliflozin (E) group and followed up for 24 weeks. The primary endpoint was the mean percentage change from baseline in NT-proBNP level after 24 weeks. There was significant improvement from baseline in mean NT-proBNP level in both groups after 24 weeks. However, there was no significant difference between the two groups (P = .214). The mean NT-proBNP level improved from 2078.15 ± 1764.70 pg/mL at baseline to 1185.06 ± 1164.21 pg/mL at 6 months in the R-group (P ≤ .001) and from 2283.98 ± 1759.15 pg/mL at baseline to 1395.33 ± 1304.18 pg/mL at 6 months in the E-group (P < .001). LVEF and LV volumes improved in both groups. The glycemic parameters (HbA1c, FPG, and PPG) demonstrated a significant reduction from baseline to week 24 in both groups. Similar improvement was seen in heart rate, blood pressure, and weight reduction over 6 months in both groups. There was no drug-related serious adverse events in any group. Remogliflozin and empagliflozin significantly improve glycemic parameters and NT-proBNP levels as the index of the therapeutic effects in T2DM patients with CHF. The positive effects are comparable in both groups.