Solving the calcium gluconate shortage in real-time: Mistakes made and lessons learned.

PURPOSE: During a national shortage of calcium gluconate, we switched to calcium chloride for routine supplementation for peripheral blood stem cell (PBSC) collections. Subsequently, we analyzed the postprocedure ionized calcium level, as we aimed for an equivalent result compared to before the shortage. METHODS: Pharmacy representatives helped us to find an "equivalent" substitute for calcium gluconate at 46.5 mEq in 500 mL normal saline, infused at 100 mL/hour. After instituting a presumably comparable protocol using calcium chloride (40.8 mEq in 250 mL normal saline at a rate of 100 mL/hour), we reviewed ionized calcium results post-PBSC procedures to compare with those obtained with calcium gluconate. Having noticed a difference in the mean values, we adjusted the rate of calcium chloride to reach our desired outcome. RESULTS: Twenty-seven procedures were analyzed on 15 unique patients. We used the Spectra OPTIA with a whole blood: anticoagulant ratio of 13:1. Ionized calcium levels post-PBSC collection with the first calcium chloride protocol were significantly higher (P = 0.003) in nine patients treated. Subsequently, we decreased the calcium chloride infusion rate to 75 mL/hour and achieved similar mean levels to calcium gluconate (P = 0.382). CONCLUSION: Changes in replacement fluids for apheresis procedures can be complex, particularly when dealing with electrolytes that could be clinically significant at critically high or low levels. Once we recognized the need to take into account the amount of elemental calcium infused, we achieved the desired postprocedure ionized calcium results. This study can serve as a lesson for future shortages of infusions used during apheresis procedures.

Effect of treatment with oral Ca boluses following calving on concentrations of Ca in serum in pasture-based dairy cows.

AIMS To assess the effect of the administration of two oral Ca boluses on concentrations of total Ca, ß-hydoxybutyrate (BHB) and non-esterified fatty acids (NEFA) in serum, and urine pH, in recently calved pasture-fed dairy cows. METHODS Friesian or Friesian cross Jersey cows from one dairy farm were blocked by age and randomly assigned to no treatment (control; n=14), or treatment (n=13) with two oral Ca boluses administered approximately 12 hours apart, with the first bolus being given within 14 hours of calving. Each bolus weighed 198 g and contained 43 g of Ca; 31 g of Ca from calcium chloride and 12 g of Ca from calcium sulfate. Cows were enrolled over three calendar days, and all cows were managed in one group during the 24-hour study period. Blood samples were collected at 0, 1, 2, 4, 8, 12, 13, 14, 16, 20 and 24 hours after the initial treatment. Serum from each time point was analysed for concentrations of total Ca, and from 0, 12, and 24 hours for NEFA and BHB. Urine was collected at 0, 12 and 24 hours for pH measurement and pH was categorised as <7 or ≥7. The effect of treatment on percentage change in concentrations of Ca in serum relative to 0 hours, and concentrations of NEFA, BHB and urine pH, was examined using multivariable repeated measures mixed models with cow as a random effect. RESULTS In the final multivariable model for percentage change in concentrations of Ca, there was an interaction between time and treatment (p=0.004), with the percentage increase being higher in treatment than control cows at 1, 2, 4, 8 and 13 hours. At 12 hours, 5/13 (41%) treated cows had a urine pH <7compared to 0/12 (0%) control cows (p<0.001), and at 24 hours 13/13 (100%) treated cows had urine pH <7 compared to 0/12 (0%) control cows (p<0.001). Over the 24-hour period, mean concentrations of NEFA or BHB in serum were similar in treated and control cows (p>0.3). CONCLUSIONS AND CLINICAL RELEVANCE Oral treatment with two Ca boluses increased concentrations of total Ca in serum and decreased urine pH in pasture-fed cows. This bolus has the potential to reduce the prevalence and duration of subclinical hypocalcaemia in recently calved cows.

Effects of oral calcium supplementation on mineral and acid-base status, energy metabolites, and health of postpartum dairy cows.

Two experiments were conducted to characterize blood concentrations of minerals and acid-base status after oral dosing of Ca salts and to determine the effects of oral Ca on mineral and metabolic status and incidence diseases. The hypotheses were that administration of oral Ca as CaCl2 and CaSO4 maintains blood total Ca (tCa) concentrations ≥2.125 mM and reduces the incidence of diseases in early lactation. In experiment 1, 18 Holstein cows on the day of calving were assigned to receive a single dose of 0, 43, or 86g of Ca as an oral bolus. Blood was sampled before and after treatments to characterize acid-base status and concentrations of minerals. In experiment 2, 450 Holstein cows considered of low (LRM; normal calving) or high risk (HRM; dystocia, twins, stillbirth, retained placenta, vulvo-vaginal laceration, or a combination of these) of metritis (primiparous-LRM=84; primiparous-HRM=84; multiparous-LRM=138; multiparous-HRM=138) on the day of calving were blocked by parity and then randomly assigned to control, no Ca supplementation; 86g of Ca on d 0 and 1 postpartum (CaS1); or 86g of Ca on d 0 and 1 postpartum followed by 43g/d on d 2 to 4 postpartum (CaS4). Blood was sampled before and 30 min after treatment on d 0, and 30 min after treatments on d 1 to 4, and d 7 and 10 for determination of concentrations of minerals and metabolites and blood acid-base responses. Disease incidence was evaluated for the first 30 DIM. Concentrations of ionized Ca (iCa) increased for 2h in cows supplemented with 43g of Ca and fewer than 8h in cows supplemented with 86g of Ca. The changes in iCa concentrations from pretreatment to 30 min after 86g of Ca supplemented on d 0 were 0.11±0.03 mM in multiparous cows and 0.25±0.03 mM in primiparous cows. Oral Ca reduced the incidence of subclinical hypocalcemia (SCH; tCa <2.125mM) in the first 4 d in the experiment (control=69.3%; CaS1=57.5%; CaS4=34.2%). Calcium supplementation decreased the prevalence of SCH on d 0 and 1 postpartum in all cows. Stopping oral Ca in CaS1 on d 1 postpartum, however, caused a rebound in SCH on d 2 to 4 postpartum in primiparous cows. Oral Ca increased the incidence of metritis (control=22.7%; CaS1=34.8%; CaS4=32.8%), primarily because of an increase in LRM primiparous cows (control=17.9%; CaS1=35.7%; CaS4=42.9%). Oral Ca increased morbidity in primiparous cows (control=38.1%; CaS1=61.8%; CaS4=60.3%) but had no effect on multiparous cows (control=38.2%; CaS1=35.1%; CaS4=30.1%). Large doses of oral Ca as salts of chloride and sulfate in the first days postpartum should be avoided in primiparous cows and used only in cows at risk of clinical hypocalcemia.

[CORRECTION OF HEMOSTASIS DISORDER IN HEMORRHAGIC SHOCK].

It is a clinical case of successful correction of hemostasis disorder in hemorrhagic shock. This case demonstrates the need to perform advanced tests that assess hemostatic system in patients with ongoing bleeding. Using of thromboelastography helped us to make a comprehensive assessment of hemostatic system that allowed to detect the point of application of drugs and substitution therapy. Coagulation disorder was treated by intravenous injection of Ca2+. In this case the cause of hypocalcemia was combination offactors such as electrolytes losing during massive bleeding and progressing metabolic acidosis. Therefore, monitoring the level of ionized calcium is especially important in patients undergoing massive blood loss and receiving large doses of donor blood components.

Effect of hyperbaric oxygen treatment in a rat model of abdominal aortic aneurysm.

Matrix metalloproteinase (MMP) plays a pivotal role in the pathophysiology of abdominal aortic aneurysms (AAA). Experimental studies have demonstrated that hyperbaric oxygen (HBO2) therapy decreases MMP levels in different tissues. However, the effect of HBO2 therapy on AAA has yet to be investigated. This study aimed to examine the effects of HBO2 on MMPs in an experimental AAA model. The model was implemented with CaCl2 in 12-week-old male Wistar albino rats. The rats were randomized into four groups: Group I: received NaCl (n = 6) (Sham group); Group II: received NaCl and were treated with HBO2 (n = 6); Group III: received CaCl2 (n = 6); and Group IV: received CaCl2 and were treated with HBO2 (n = 6). HBO2 therapy was applied for five of seven days over a period of six weeks. Although in the CaCl2 groups, aortic diameters were significantly higher than the NaCl groups (p < 0.05), there was no difference between pre- and post-HBO2 in the CaCl2 groups (p > 0.05). In the CaCl2 group, the MMP-2 and MMP-9 levels were significantly higher than those in the NaCl group (p < 0.05). HBO2 therapy had no statistically significant effect on the MMP-2 and MMP-9 levels in Groups III and IV. However, it was observed that both levels clearly decreased in Group IV. In conclusion, the study suggested that HBO2 may have favorable effects on MMP levels.

Initial large-dose administration of modified St. Thomas' solution.

BACKGROUND: We introduced an initial large dose of modified St. Thomas' Hospital cardioplegic solution with the aim of providing both myocardial protection as well as a smooth intraoperative process. METHODS: In 90 cases of isolated aortic valve replacement, we used the modified technique of cardioplegia in 45 (group S) and conventional administration of glucose-insulin-potassium solution in 45 (group G). The patients were selected at random. In group S, we added 4 mEq of potassium to the original St. Thomas' Hospital solution and administered 30 mL·kg(-1) as an initial dose. The temperature was decreased to 2. RESULTS: The mean of reperfusion time after declamping in group S was significantly shorter (16.7 ± 6.4 vs. 21.5 ± 10.0 min; p = 0.007). The average of postoperative maximum creatine kinase-MB was significantly lower in group S (25.6 ± 9.5 vs. 40.6 ± 37.2 IU·L(-1); p = 0.014). On multivariate analysis, use of the modified cardioplegia and aortic crossclamp time were significantly associated with creatine kinase-MB level and reperfusion time after declamping. CONCLUSIONS: This modified technique was an acceptable option that provided a bloodless operative field and avoided multiple cardioplegic administrations.

Enteral calcium infusion used successfully as treatment for a patient with hereditary vitamin D resistant rickets (HVDRR) without alopecia: a novel mutation.

BACKGROUND: We report a novel mutation in a case of hereditary vitamin D resistant rickets (HVDRR) without alopecia and successful management of this condition with the intravenous formulation of calcium chloride delivered via gastric tube. CLINICAL CASE: A 22 month old male (length -3.4 SDS; weight -2.1 SDS) presented with failure to thrive, short stature, severe hypocalcemia and gross motor delay. He did not have alopecia. Initial blood tests and history were thought possibly to suggest vitamin D deficiency rickets: calcium 5.1mg/dL, (8.8-10.8); phosphorus 4.1mg/dL, (4.5-5.5); alkaline phosphatase 1481 U/L (80-220); intact PTH 537.1 pg/mL (10-71). Subsequently, vitamin D studies returned that were consistent with HVDRR: 25-hydroxyvitamin D 34 ng/mL (20-100); 1,25-dihydroxyvitamin D 507 pg/mL. This diagnosis was confirmed by DNA sequencing. His subsequent clinical course was complicated by the fact that IV calcium was not a viable option for this patient, and his calcium levels could not be well controlled on oral calcium citrate or calcium glubionate therapy. Eventually, we were able to maintain calcium levels above 8 mg/dL using the intravenous preparation of calcium chloride administered via gastric tube. GENETIC STUDIES: A unique homozygous T to C base substitution was found in exon 6 in the vitamin D receptor (VDR) gene. This mutation causes leucine to be converted to proline at position 227 in helix 3 in the VDR ligand binding domain (LBD). The mutation rendered the VDR non-functional, leading to HVDRR, with absence of alopecia. CONCLUSION: HVDRR should be considered in a patient with profound hypocalcemia which is refractory to conventional therapy of vitamin D deficiency rickets even without evidence of alopecia. We report the first case of HVDRR with a novel mutation in the LBD that was successfully treated with enteral treatment using a calcium chloride infusion.

Effect of calcium sprays on mechanical strength and cell wall fractions of herbaceous peony (Paeonia lactiflora pall.) inflorescence stems.

Calcium is an essential element and imparts significant structural rigidity to the plant cell walls, which provide the main mechanical support to the entire plant. In order to increase the mechanical strength of the inflorescence stems of herbaceous peony, the stems are treated with calcium chloride. The results shows that preharvest sprays with 4% (w/v) calcium chloride three times after bud emergence are the best at strengthening "Da Fugui" peonies' stems. Calcium sprays increased the concentrations of endogenous calcium, total pectin content as well as cell wall fractions in herbaceous peonies stems, and significantly increased the contents of them in the top segment. Correlation analysis showed that the breaking force of the top segment of peonies' stems was positively correlated with the ratio of water insoluble pectin to water soluble pectin (R = 0.673) as well as lignin contents (R = 0.926) after calcium applications.

Effect of calcium treatment on blood parameters, gonadal development and the structure of bone in immature female rats.

Calcium is an essential nutrient required for critical biological functions. Calcium supplementation is to be evaluated using immature female rats. The present study focused on some blood parameters, gonadal development and bone structure. Forty immature female Sprague-Dawley rats were randomly divided into four equal-sized groups (80 g average body weight) to receive calcium chloride dihydrate (group I: control; groups II, III and IV: received 20 mg, 40 mg and 60 mg per kg body weight, respectively) for 5 weeks. Rats were decapitated, and their trunk blood was sampled for biochemical assays. Cholesterol, triglycerides, glucose and calcium were measured. Gonadal and bone structure were histologically evaluated. Results revealed that treatment of developing female rats with three calcium doses used have no marked effect on the serum calcium and cholesterol levels. However, serum triglyceride level and body weight gain are significantly decreased in rats treated with all of the three calcium doses. Serum glucose level showed a marked increase in animals treated with the higher calcium doses. Moreover, observable histological alterations are recognized in the ovaries. Bones of the experimental animals also showed morphological alterations. These results suggest that increasing calcium supplementation decreases triglycerides and percentage body weight gain and positively affects the bone and gonadal development.

Concomitant ceftriaxone and high-concentration intravenous calcium therapy in adult critical care patients: a matched cohort study.

BACKGROUND: Based on case reports in infants, the safety of concomitant use of ceftriaxone and intravenous calcium in all ages has recently come under challenge. Systematic population-based data to guide clinicians with respect to this risk are, however, lacking. OBJECTIVE: To determine whether concomitant administration of ceftriaxone and intravenous calcium was associated with the occurrence of severe cardiorespiratory events or death in critically ill adults. METHODS: We performed a matched-cohort study from retrospective data of adults admitted to intensive care units (ICUs) in Calgary, Canada, who were provided continuous high-dose intravenous calcium. Those who received ceftriaxone while on continuous renal replacement therapy were considered exposed. Up to 3 unexposed patients were selected by matching on a number of prognostic factors from the remaining subjects not concurrently exposed to ceftriaxone and calcium. Univariate methods and multivariate conditional logistic regression were used for statistical analysis. RESULTS: We identified 142 patients exposed to the implicated combination who could be matched to at least one unexposed patient. Hospital mortality was 66% in the exposed versus 63% in unexposed patients (p = 0.442). ICU length of stay, ICU mortality, hospital length of stay, and the frequency of acute oxygenation events were all similar by univariate analysis. Multivariate conditional logistic regression modeling failed to find a significant association between exposure and hospital mortality (adjusted OR 1.15, 95% CI 0.65 to 2.04) or other relevant outcomes. CONCLUSIONS: In this high-risk group, administration of high concentrations of calcium and concurrent ceftriaxone was not significantly associated with greater mortality or adverse outcomes compared to matched unexposed patients. Although this was an underpowered study and rare adverse effects from the interaction of these 2 compounds cannot be completely excluded, these data provide overall reassurance of the safety of this combination in the majority of critically ill adults.

Effects of postharvest application of 1-MCP and postcutting dip treatment on the quality and nutritional properties of fresh-cut kiwifruit.

Consumption of minimally processed fruit and vegetables has increased significantly in the past few years due to the consumers' life style. The aim of this study was to evaluate the effect of treatment with ascorbic acid or calcium chloride on the quality parameters of fresh-cut kiwifruit prepared from fruit previously stored for 3 months, either treated or not treated with 1-methylcyclopropene (1-MCP) before storage. Harvested fruit were treated with 1 microL L(-1) 1-MCP for 20 h at room temperature ( approximately 20 degrees C) (MCP) or had no treatment (C) and were then stored at 0 degrees C. After 3 months, fruit were removed from storage, peeled, and cut longitudinally in quarters, dipped in 2% ascorbic acid (Asc), 2% calcium chloride (Ca), or just water (cont), and kept at 2 degrees C for 8 days. Measurements of firmness, soluble solids content (SSC) ( degrees Brix), color (CIE L*, a*, b*), electrolyte leakage, sugars, organic acids, total phenolics, and antioxidant activity (DPPH and ABTS) were performed at 0, 4, and 8 days. A taste panel was performed on the seventh shelf life day. It was shown that whole MCP-treated kiwifruit kept better than the control through the 3 months storage, this effect being lost through the fresh-cut shelf life period. Furthermore, the postcut dip on 2% CaCl(2) was effective on delaying softening and browning of fresh-cut kiwifruit, which were also the fruit preferred by panelists. Both ascorbic acid and CaCl(2) were effective on preserving or improving nutritional properties (phenolics, ascorbic acid, DPPH, and ABTS) mainly in the first 4 days of shelf life. The CaCl(2) had a further beneficial effect until 8 shelf life days. It is suggested that CaCl(2) is better in keeping overall quality through 8 days of shelf life at 2 degrees C in fresh-cut kiwifruit followed by Asc, and 1-MCP has negligible effect in the conditions of this experiment.

Effects of calcium chloride and calcium sulfate in an oral bolus given as a supplement to postpartum dairy cows.

An oral calcium bolus (Bovikalc, Boehringer Ingelheim Vetmedica) supplying calcium to dairy cows in the form of calcium chloride and calcium sulfate was evaluated to determine the effect on calcium homeostasis immediately after calving. Cows in the treatment group received one bolus immediately after calving and a second bolus 12 hours later. Control cows received no calcium supplementation. Blood was analyzed for ionized calcium, and urine was collected for urinary pH determination. Postpartum supplementation with the Bovikalc bolus significantly increased serum ionized calcium levels and decreased urine pH values.

Safety evaluation of calcium administered intranasally to mice.

Calcium, a component of approved human vaccines administered via systemic routes, has a good safety profile. Recently, intranasally administered vaccines containing calcium have shown promise in generating mucosal immune responses in animal models. However, the safety of intranasally administered calcium is unknown. This study evaluates the safety of intranasally administered calcium at 2- to 13-fold higher doses than used in experimental vaccines. At a calcium dose of 22 mg/kg, 80% of the Balb/c and 20% of the C57BL/6 mice die within the first 24 hours. At 11.0 mg/kg, there is no overt toxicity in either strain, based on body weight, clinical scores, blood chemistry, and histopathology of major organs at 7 days post administration. In C57BL/6 mice, apart from acute and subacute inflammation in the lungs at up to 3 days post administration, especially at the 22-mg/kg dose, there is no overt toxicity. Doses of calcium up to 11 mg/kg appear to be safe in a mouse model.

Parenteral calcium for intensive care unit patients.

BACKGROUND: Hypocalcemia is prevalent among critically ill patients requiring intensive care. Several epidemiological studies highlight a direct association between hypocalcemia and mortality. These data provide the impetus for current guidelines recommending parenteral calcium administration to normalize serum calcium. However, in light of the considerable variation in the threshold for calcium replacement, the lack of evidence to support a causal role of hypocalcemia in mortality, and animal studies illustrating that calcium supplementation may worsen outcomes, a systematic review is essential to evaluate whether or not the practice of calcium supplementation for intensive care unit (ICU) patients provides any benefit. OBJECTIVES: To assess the effects of parenteral calcium administration in ICU patients on the following outcomes: mortality, multiple organ dysfunction, ICU and hospital length of stay, costs, serum ionized calcium concentration, and complications of parenteral calcium administration. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, Current Controlled Trials, and the National Research Register. We hand-searched conference abstracts from the Society of Critical Care Medicine, the European Society of Intensive Care Medicine, the American Thoracic Surgery, the American College of Surgeons, the American College of Chest Physicians, the American College of Physicians, and the International Consensus Conference in Intensive Care Medicine. We checked references of publications and attempted to contact authors to identify additional published or unpublished data. SELECTION CRITERIA: Randomised controlled and controlled clinical trials of ICU patients comparing parenteral calcium chloride or calcium gluconate administration with no treatment or placebo. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied eligibility criteria to trial reports for inclusion and extracted data. MAIN RESULTS: There are no identifiable studies that have evaluated the association between parenteral calcium supplementation in critically ill ICU patients and the following outcomes: mortality, multiple organ dysfunction, ICU and hospital length of stay, costs, and complications of calcium administration. Serum ionized calcium concentration was reported in 5 studies (12 trial arms, 159 participants). These trials showed a small but significant increase in serum ionized calcium concentration after calcium administration. These trials showed considerable statistical heterogeneity and differed extensively in the population studied (adult versus neonate), the indication (hypocalcemia versus prophylaxis) and threshold of hypocalcemia for which parenteral calcium was administered, and the timing of subsequent measurement of serum ionized calcium concentration to the extent that we consider a pooled estimate almost inappropriate. AUTHORS' CONCLUSIONS: There is no clear evidence that parenteral calcium supplementation impacts the outcome of critically ill patients.

Effect of various calcium/phosphates ratios of carboxymethylcellulose-based saliva substitutes on mineral loss of bovine enamel in vitro.

OBJECTIVES: The present study evaluated the effects of various calcium and phosphate concentrations and ratios of carboxymethylcellulose (CMC)-based solutions on the mineral loss of predemineralised bovine enamel in vitro. METHODS: Bovine enamel specimens were prepared, polished and partly covered with nail varnish, thus serving as control of sound enamel. After demineralisation (37 degrees C; pH 5.0; 14 days) the specimens were exposed to CMC-based solutions (20g/l) with various saturations with respect to apatites containing 0.1mM NaF, CaCl2 (0-32 mM) and KH2PO4 (0-52 mM) at two different pH values (5.5 or 6.5). A fluoride-free solution served as control, and four commercially available products were tested as well. The differences in mineral loss (DeltaDeltaZ) between the values prior to (DeltaZ Demin) and after storage (DeltaZ Effect) in the various solutions were evaluated from microradiographs of thin sections (100microm). RESULTS: The general linear model revealed a significant dependency for DeltaDeltaZ on 'calcium' (p<0.001), 'phosphate' (p=0.023), 'fluoride' (p=0.002) and 'pH' (p<0.001). With increasing calcium and phosphate concentrations an increase in DeltaDeltaZ could be observed up to the solution containing the third highest saturation with respect to octacalciumphosphate (3.2), showing a significant remineralisation (p<0.05; t-test). The commercially available products as well as the control groups revealed significantly reduced DeltaDeltaZ values compared to this group (p<0.01; Bonferroni). CONCLUSIONS: A saturation with respect to octacalciumphosphate of 3.2 and a pH of 6.5 enables CMC-based solutions to remineralise bovine enamel in vitro.

Influence of heating on oil-in-water emulsions prepared with soybean soluble polysaccharide.

The effect of heating on the physicochemical properties of emulsions prepared with soybean soluble polysaccharide (SSPS) was investigated. The emulsions were stable after heating at 90 degrees C for up to 30 min. Heating at different pH values or in the presence of CaCl2 (<10 mM) did not affect the stability; however, at higher concentrations of calcium ions, the emulsion particle size increased. Two fractions, a high molecular weight (HMF) and a low molecular weight (LMF) fraction, were separated from the crude SSPS preparation by gel fitration. Emulsions prepared with SSPS/HMF (MW = 310-420 kDa) showed little change in size with heating, while the protein impurities of the SSPS/LMF fraction formed aggregates by heating at pH 7. Analysis of the heat-induced aggregation of the two fractions of SSPS suggested that the changes in SSPS functionality with heating can be attributed to the protein impurities (LMF) present in the SSPS.

Vacuum infusion of plant or fungal pectinmethylesterase and calcium affects the texture and structure of eggplant.

The effect of vacuum infusion on eggplant quality of a commercial fungal (Aspergillus niger) and citrus pectinmethylesterase (PME) with calcium chloride (4000 ppm) was investigated after processing and during storage. Firmness of infused eggplants using fungal or citrus PME was significantly increased compared to controls (fresh noninfused and water-infused control) after processing and during storage for 7 days at 4 degrees C. Activity of fungal PME-infused eggplant increased almost 32 times, whereas activity of eggplant infused with Marsh grapefruit PME increased 2-fold. Degree of esterification of pectin of eggplants infused with fungal or citrus PME decreased slightly. Cryo-SEM showed that samples treated with fungal PME/ CaCl2 displayed more integrity among cells as compared with water-infused control. The change of pectin in the cell wall was visualized using monoclonal antibodies JIM5 (low-esterified pectin) and JIM7 (high-esterified pectin). JIM5 showed more binding than JIM7 with the cell walls of eggplant tissues from fungal PME/ CaCl2 treatment.

Comparison of methods for point of care preparation of autologous platelet gel.

A platelet gel (PG) is produced by the addition of calcium chloride and thrombin to a platelet concentrate (PC). PG releases multiple growth factors, which have the ability to initiate and stimulate one growth factor's function in the presence of others. This finding has resulted in the use of PG in orthopedic, plastic, and reconstructive surgery. The study compared the commercial systems available for the preparation of PG. All procedures were performed according to the manufacturers directions. The devices were evaluated with respect to ease of use, collection efficiency, platelet quality, and growth factor release. The SmartPReP requires only four processing steps compared to 12 to 24 required by other devices. The SmartPReP and the CATS were the most reproducible, as evidenced by their low coefficient of variation of 13% and 16%. The mean platelet yield was 72% for the SmartPReP, 58% for the 3iPCCS, 54% for the Sequestra, 31% for the Secquire, 31% for the CATS, 27% for the Interpore Cross, and 42.6% for the Biomet GPS. The mean total amount of PDGF-AB and TGF-B1 obtained from the SmartPReP is greater than other systems evaluated. The SmartPReP produced a consistent PC with a yield that was four times baseline range with the lowest coefficient of variation.

Dose-dependent hemodynamic effect of digoxin therapy in severe verapamil toxicity.

UNLABELLED: Calcium chloride (CaCl(2)) alone is an ineffective antidote in severe calcium channel antagonist overdoses. Digoxin has been evaluated as a therapy to increase the effectiveness of calcium in severe calcium channel antagonist overdoses. OBJECTIVE: To determine if there is a dose-dependent hemodynamic effect of digoxin in the setting of severe verapamil toxicity treated with high-dose CaCl(2). METHODS: Eight dogs were instrumented to measure systolic and diastolic blood pressure, cardiac output, pulmonary artery pressures, and left ventricular pressures. Verapamil toxicity (50% decrease in mean arterial pressure) was induced with verapamil 6 mg/kg/hr and maintained for 30 minutes by titrating the verapamil rate. Following verapamil toxicity, each dog received one dose of digoxin equivalent to 0, 1, 1.5, 2, 3, 4, 6, or 8 times the loading dose of digoxin (0.009 mg/kg). The verapamil rate was changed to 4 mg/kg/hr and continued for the next five hours. CaCl(2) boluses were given (0.5 g immediately following verapamil toxicity and 1 g at one, two, and three hours). Measurements were compared with the loading dose of digoxin using linear regression analysis. RESULTS: Digoxin resulted in a dose-dependent increase in systolic blood pressure at 4 hours (10.23 mm Hg/loading dose of digoxin, 95% CI = 2.74 to 17.73), 4 hours, 15 minutes (13.9 mm Hg/loading dose of digoxin, 95% CI = 8.75 to 19.01), and 5 hours (17.04 mm Hg/loading dose of digoxin, 95% CI = 1.76 to 32.32). Digoxin resulted in a dose-dependent increase in maximal ventricular pressure at the end of hour 3 (8.55 mm Hg/loading dose of digoxin, 95% CI = 3.41 to 13.69), 3 hours, 15 minutes (11.81 mm Hg/loading dose of digoxin, 95% CI = 4.89 to 18.73), hour 4 (8.26 mm Hg/loading dose of digoxin, 95% CI = 1.03 to 15.48), and 4 hours, 15 minutes (9.74 mm Hg/loading dose of digoxin, 95% CI = 4.47 to 15.00). The authors were unable to detect a dose-dependent increase in other parameters, including diastolic relaxation (diastolic change in pressure over time) and time to onset of death. No ventricular arrhythmias developed in any dogs. CONCLUSIONS: There is a dose-dependent effect of digoxin on systolic blood pressure and maximal ventricular pressure in the setting of severe verapamil toxicity treated with high-dose CaCl(2).