Randomized trial of oral sulfate solution versus polyethylene glycol-ascorbic acid for bowel cleansing in elderly people.

BACKGROUND AND AIM: The efficacy and safety of the recently introduced low-volume purgatives in elderly people are not well known. Therefore, in this trial, we aimed to evaluate and compare the efficacy of two low-volume agents, oral sulfate solution (OSS) and 2-L polyethylene glycol with ascorbic acid (PEG-Asc), in elderly people. METHODS: A prospective, randomized, single-blinded, multicenter, non-inferiority trial was performed at three university-affiliated hospitals in South Korea. Outpatients aged 65-80 years, who underwent elective colonoscopy, were enrolled. The primary outcome was the rate of adequate bowel preparation assessed using the Boston Bowel Preparation Scale. RESULTS: A total of 199 subjects were randomized into the OSS (n = 99) or the 2-L PEG-Asc (n = 100) group. Of them, 189 subjects were included in the analysis of the primary outcome (OSS group 95 vs PEG-Asc group 94). The proportion of adequate bowel preparation was 89.5% (85/95) in the OSS group and 93.6% (88/94) in the 2-L PEG-Asc group. OSS was not inferior to 2-L PEG-Asc according to the prespecified non-inferiority margin of -15% (95% confidence interval for the difference, -12.1 to 3.8). Vomiting (11.6% vs 2.1%) and thirst (24.2% vs 11.7%) were more common in the OSS group than in the 2-L PEG-Asc group. CONCLUSIONS: OSS is an effective low-volume purgative that is non-inferior to 2-L PEG-Asc in elderly people. Both the low-volume agents were identified to be well tolerated and safe in the healthy elderly population.

Formulation of Suppositories of Alum Produced from Bauxite Waste in Ghana for the Treatment of Hemorrhoid.

The study sought to formulate and evaluate suppositories using a locally produced brand of alum (Aw) obtained from bauxite waste generated at Awaso bauxite mine in the Western-North region of Ghana, for use in the treatment of hemorrhoids. The suppositories were formulated using shea butter modified, respectively, with amounts of beeswax and theobroma oil. In another development, theobroma oil was modified with different concentrations of beeswax. Drug-base interactions were investigated using attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy. The suppositories were prepared using the hot melt and trituration methods. Quality control checks were carried out on the formulations. The evaluated parameters included physical characteristics (texture, presence or absence of entrapped air, and contraction holes), weight uniformity, disintegration time, drug content, and in vitro release profile of the alum from the formulated suppositories. An in vivo analysis was carried out on the most suitable formulation to ascertain its efficacy on inflamed tissues using croton oil-induced rectal inflammation in a rat model. A critical examination of the ATR-FTIR spectra revealed no drug-base interactions. The suppository formulations passed all Pharmacopoeia stated tests. The in vivo study revealed the use of suppositories ameliorated the croton oil-induced hemorrhoid in the rectoanal region of the rats.

The non-specific antiviral activity of polysulfates to fight SARS-CoV-2, its mutants and viruses with cationic spikes.

Polyanions are negatively charged macromolecules known for several decades as inhibitors of many viruses in vitro, notably AIDS virus. In the case of enveloped viruses, this activity was assigned to the formation of a polyelectrolyte complex between an anionic species, the polyanion, and the spike cationic proteins which are, for polymer chemists, comparable to cationic polyelectrolytes. Unfortunately, in vitro antiviral activity was not confirmed in vivo, possibly because polyanions were captured by cationic blood elements before reaching target cells. Accordingly, virologists abandoned the use of polyanions for antiviral therapy. In the case of coronaviruses like SARS-CoV-2 and its mutants the game may not be over because these viruses infect cells of airways and not of blood. This communication proposes strategies to use polysulfates to attack and inhibit viral particles before they reach target cells in the airways. For this, polysulfate solutions may be administered by spray, gargling and nebulization or used to capture virus-containing droplets and aerosols by bubbling when these vectors are in the atmosphere. The technical means exist. However, biocompatibility and biofunctionality tests are necessary in the case of airways. Such tests require manipulation of pathogens, something which is beyond the competences of a biomaterialist. For this, a specialist in virology is necessary. Attempts to find one failed so far despite all-around solicitations over the past ten months and despite the fact that attacking the virus with polysulfates may complement beneficially the defensive strategies based on masks, vaccines and hospitals.

The clinical efficacy of external application of mirabilite and rhubarb combined with intrathoracic chemotherapy in treating malignant pleural effusion: A prospective, randomized, controlled clinical trial.

BACKGROUND: Malignant pleural effusion (MPE) is one of the commonest causes of an exudative pleural effusion. Breathlessness, dyspnea and other symptoms often seriously distress and affect the quality of life. The external application of mirabilite and rhubarb (EAMR) combined with intrathoracic infusion of cisplatin, as an alternative treatment for MPE, is popular in China. The study aims to assess its effectiveness and safety combined with intrathoracic chemotherapy. METHODS: This study is a prospective, randomized controlled clinical trial. Patient visits were performed at baseline and days 14 and 28 after treatment. Clinical outcomes were measured after chest drain placement using the criterion of efficacy refer to WHO standard, and QLQ-C30 questionnaire. RESULTS: Database records of patients treated in our institution for MPE between October, 2016 and March, 2019. The study included 84 eligible patients. They were categorized with a randomization schedule into treatment group (N = 42) and control group (N = 42). There is statistical significance in the comparison of the total effective rate between these 2 groups (66.67% vs 54.76%, P < .05). Furthermore, there is statistical significance in the comparison of items of Physical (1.95 ±â€Š0.50 vs 2.19 ±â€Š0.58%, P < .05), Pain (1.98 ±â€Š0.42 vs 2.07 ±â€Š0.32, P < .05), and Global Health (1.23 ±â€Š0.64 vs 1.13 ±â€Š0.23%, P < .05) between these 2 groups. None of the patients had adverse reactions such as skin allergy and chest tightness. CONCLUSIONS: The total effective rate of treatment group using extra external application of mirabilite rhubarb powder is significantly higher than that of control group. The improvement of patients' clinical symptoms is greater in treatment group and no adverse reactions is found. Therefore, external application of mirabilite and rhubarb combined with intrathoracic infusion of cisplatin is an effective method for the treatment of MPE, which is worth popularizing.

Paeonol alleviates dextran sodium sulfate induced colitis involving Candida albicans-associated dysbiosis.

Inflammatory bowel disease (IBD), which consists of ulcerative colitis (UC) and Crohn's disease (CD), is a chronic inflammatory disorder of the gastrointestinal tract. Occurrence and development of UC have been associated with multiple potential causative factors, which include fungal dysbiosis. Growing evidence reveals that Candida albicans-associated dysbiosis is correlated with clinical deterioration in UC. Paeonol (PAE) is a commonly used traditional medicine with multiple reported properties including effective alleviation of UC. In this study, a murine UC model was established by colonizing mice with additional C. albicans via gavage prior to dextran sodium sulfate (DSS) administration. Effects of PAE treatment were also assessed at initiation and in preestablished C. albicans-associated colitis. The results showed that C. albicans supplementation could aggravate disease activity index (DAI), compromise mucosal integrity, exacerbate fecal and tissue fungal burdens, increase serum ß-glucan and anti-Saccharomyces cerevisiae antibody (ASCA) levels, promote serum and colonic tissue pro-inflammatory cytokine secretion (tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-6, and IL-8) and decrease the anti-inflammatory cytokine IL-10 level. It also stimulated Dectin-1, TLR2 and TLR4 as well as expression of their downstream effector NF-κB in colonic tissue. After PAE treatment, the adverse impacts of C. albicans on colitis were relieved, via decreased receptor-associated local and systemic inflammation. Our study suggests that PAE should be a candidate for treatment of fungal dysbiosis-associated UC and may act through the Dectin-1/NF-κB pathway in collaboration with TLR2 and TLR4. LAY SUMMARY: Candida albicans is believed to be an important stimulator in ulcerative colitice (UC) development. Suppressing the growth of intestinal C. albicans can be contributory to the amelioration of UC. Paeonol (PAE) is a commonly used traditional medicine with multiple biological functions. In this study, we observed that PAE could alleviate symptoms in mice UC model accompanying with burden reduction of C. albicans. Therefore, we suppose that PAE can be a candidate in the treatment of C. albicans-associated UC.

Dietary Supplementation with Sodium Sulfate Improves Rumen Fermentation, Fiber Digestibility, and the Plasma Metabolome through Modulation of Rumen Bacterial Communities in Steers.

Six steers were used to study the effects of dietary supplementation with sodium sulfate (Na2SO4) on rumen fermentation, nutrient digestion, rumen microbiota, and plasma metabolites. The animals were fed a basal ration with Na2SO4 added at 0 g/day (sulfur [S] content of 0.115% dry matter [DM]), 20 g/day (S at 0.185% DM), or 40 g/day (S at 0.255% DM) in a replicate 3-by-3 Latin square design. The results indicated that supplementing with Na2SO4 increased the ruminal concentration of total volatile fatty acids, the molar proportions of acetate and butyrate, the ruminal concentrations of microbial protein, SO42--S, and S2--S, and the digestibility of fiber, while it decreased the molar proportion of propionate and the ruminal concentration of ammonia nitrogen. Supplementing with Na2SO4 increased the diversity and the richness of rumen microbiota and the relative abundances of the phylum Firmicutes and genera Ruminococcus 2, Rikenellaceae RC9 gut group, and Desulfovibrio, whereas it decreased the relative abundances of the phylum Bacteroidetes and genera Prevotella 1, Prevotellaceae UCG-001, and Treponema 2 Supplementing with Na2SO4 also increased the plasma concentrations of amino acids (l-arginine, l-methionine, l-cysteine, and l-lysine), purine derivatives (xanthine and hypoxanthine), vitamins (thiamine and biotin), and lipids (acetylcarnitine and l-carnitine). It was concluded that supplementing the steer ration with Na2SO4 was beneficial for improving the rumen fermentation, fiber digestibility, and nutrient metabolism through modulating the rumen microbial community.IMPORTANCE Essential elements like nitrogen and sulfur greatly affect rumen fermentation and metabolism in ruminants. However, little knowledge is available on the effects of sulfur on the rumen microbiota and plasma metabolome. The results of the present trial demonstrated that supplementing the steer ration with sodium sulfate markedly improved rumen fermentation, fiber digestibility, and metabolism of amino acids, purine derivatives, and vitamins through effects on the ruminal microbiome. The facts obtained from the present trial clarified the possible mechanisms of the positive effects of sulfur on rumen fermentation and nutrient utilization.

Formulation, development, and in-vitro/ex-vivo evaluation of vaginal bioadhesive salbutamol sulfate tablets for preterm labor.

Preterm labor is the main cause of death and serious illness of both infants and pregnant women in Africa and worldwide. Parenteral and oral salbutamol sulfate as a B2 antagonist has been used for the treatment of preterm labor. The study aims are to formulate salbutamol sulfate non-invasive vaginal bioadhesive tablets to avoid the side effects of conventional formulations. Full factorial design 41 ×31 ×21 was used for the preparation of 24 vaginal bioadhesive tablet formulations. The independent factors were polymer type (Carbopol 934, HPMC 4000, HEC, and PEG 6000), polymer to drug ratio (1:1, 2:1, and 3:1), and diluent (lactose and mannitol). Vaginal bioadhesive tablets were evaluated for residence time and time required for release 50% of salbutamol sulfate T50% as dependent variables. The formulations were evaluated in terms of drug content, mass variation, hardness, friability, swelling index, residence time, and in-vitro drug release. Results revealed that polymer and diluent types are the most significant factors in both residence time and T50%. A strong positive correlation (0.91) between in-vitro and ex-vivo permeation was observed, which predict the best in-vivo performance of salbutamol vaginal bioadhesive tablet. Thus, salbutamol sulfate vaginal bioadhesive tablets could be a successful remedy for preterm labor.

Different effects of NaCl and Na2SO4 on soil net nitrogen mineralization in coastal wetlands.

NaCl and Na2SO4 are the foremost salt compositions in coastal wetlands, while their effects on soil net nitrogen mineralization still remain unclear. Aimed at investigating the two salt compositions on soil net nitrogen mineralization, a 30-day laboratory incubation experiment was respectively conducted by adding 5‰ NaCl and Na2SO4 to incubated coastal wetland soils under aerobic conditions. Our results showed that Na2SO4 addition increased the rates of mineralization (Rmin) by an average of 33.03% and nitrification (Rnit) by 23.84% during the incubation (p < 0.05). In contrast, NaCl addition significantly reduced Rmin by 71% and Rnit by 44% at day 7 (p < 0.05). The activities of fluorescein diacetate, arylamidase and urease in Na2SO4 addition treatments were higher than those in NaCl addition treatment. These results demonstrated the ion-specific effects of salt type on nitrogen mineralization rates and enzyme activities.

Ischemic Colitis Associated with Low-volume Oral Sulfate Solution for Bowel Preparation.

Ischemic colitis resulting from bowel preparation for colonoscopy is extremely rare, with only a small number of cases with polyethylene glycol having been reported. Here, we present a patient with ischemic colitis after administration of a low-volume oral sulfate solution (OSS). A 49-year-old female without any significant medical history experienced abdominal pain, vomiting, and hematochezia after ingestion of OSS. She complained of severe abdominal pain during colonoscopy, and diffuse edema, hyperemia, friability, and shallow erosions were present on the transverse, descending, and sigmoid colons. A mucosal biopsy revealed mixed lymphoid inflammatory cell infiltration with de-epithelialization, whereas an abdominal CT scan showed submucosal edema on the transverse colon. A diagnosis of ischemic colitis was made. The patient recovered with fluid and antibiotic therapy without significant sequelae. Although OSS is a clinically validated and generally safe bowel preparation agent, ischemic colitis is a rare complication that should be considered.

[Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions].

Optimal bowel preparation is essential for a more accurate, comfortable, and safe colonoscopy. The majority of postcolonoscopy colorectal cancers can be explained by procedural factors, mainly missed polyps or inadequate examination. Therefore the most important goal of optimal bowel preparation is to reduce the incidence of colorectal cancer. Although adequate preparation should be achieved in 85-90% or more of all colonoscopy as a quality indicator, unfortunately 20-30% shows inadequate preparation. Laxatives for oral colonoscopy bowel preparation can be classified into polyethylene glycol (PEG)-electrolyte lavage solution, osmotic laxatives, stimulant laxatives, and divided into high-volume solution (≥3 L) and low-volume solution (<3 L). The updated 2019 European Society of Gastrointestinal Endoscopy (ESGE) guideline is broadly similar to the 2014 American Society for Gastrointestinal Endoscopy (ASGE) recommendations and reaffirms the importance of split-dosing. However, new ESGE guideline, unlike the 2014 ASGE recommendation, suggests the use of high volume or low volume PEG-based regimens as well as that of non-PEG based agents that have been clinically validated for most outpatient scenarios. For effective, safe, and highly adherent bowel preparation, physicians who prescribe and implement colonoscopy should properly know the advantages and limitations, the dosing, and the timing of regimens. Recently many studies have attempted to find the most ideal regimens, and more convenient, effective, and safe regimens have been developed by reducing the dosing volume and improving the taste. The high tolerability and acceptability of the new low-volume regimens suggest us how we should use it to increase the participation of the national colorectal cancer screening program.

Dietary chloride levels affect performance and eggshell quality of laying hens by substitution of sodium sulfate for sodium chloride.

The objective of this study was to evaluate the effect of dietary chloride (Cl) levels on performance, eggshell mechanical quality, and ultrastructure in layers based on the substitution of sodium chloride (NaCl) by sodium sulfate (Na2SO4). Three hundred sixty Jing Brown laying hens aged 43 wk were randomly divided into 5 groups and fed with corn-soybean meal diets containing 0.06, 0.10, 0.15, 0.20, and 0.25% total Cl inclusion. Every group had 8 replicates of 9 birds each. The feeding trial lasted for 12 wk. The results showed dietary 0.06% Cl due to complete substitution of NaCl by Na2SO4, depressed performance (P < 0.05) from 45 to 54 wk of age, increased serum creatinine level (P < 0.05), and caused visible renal tubular atrophy. Dietary Cl levels quadratically affected breaking strength, thickness, and weight of eggshell (P < 0.05). Better eggshell quality could be obtained when NaCl was partly replaced by Na2SO4 in laying hen diets maintaining Cl level at 0.10 or 0.15%. Moreover, the eggshell ash content was affected by Cl levels in a quadratic (P < 0.001) manner, with higher values observed in the 0.10 and 0.15% Cl groups (P < 0.05). Besides, the eggshell ultrastructural data showed that the total thickness and effective thickness significantly increased (P < 0.05) and mammillary thickness decreased (P < 0.05) in the group of dietary 0.15% Cl compared with the groups of 0.06 and 0.25% Cl. In conclusion, the complete substitution of dietary NaCl by Na2SO4 may induce Cl deficiency and depress laying performance and eggshell quality. Na2SO4 could partly replace NaCl in diets for laying hens (43-54 wk of age) without adverse effects on performance at the dietary Cl level from 0.10 to 0.25%. Better eggshell quality could be obtained when NaCl was partly replaced by Na2SO4 in laying hen diets maintaining Cl level at âˆ¼0.15%.

Novel sulfate tablet PBK-1701TC versus oral sulfate solution for colon cleansing: A randomized phase 3 trial.

BACKGROUND AND AIM: PBK-1701TC is a novel sulfate tablet-based that contains 320 mg of simethicone and delivers 90% of the salt and water delivered by oral sulfate solution (OSS) preparation. This study evaluated the efficacy, safety, and tolerability of PBK-1701TC compared with OSS in bowel preparation for colonoscopy. METHODS: This randomized, multicenter, phase 3 non-inferiority trial included adults aged 19 years or older with a body mass index of 19-30 kg/m2 undergoing colonoscopy at five university hospitals in Korea. The primary efficacy endpoint was successful bowel-cleansing rate, defined as Harefield Cleansing Scale grade A or B as evaluated by blinded central readers. Secondary endpoints included the presence of residual air bubbles. Adverse events and laboratory evaluations were monitored to assess safety. Tolerability was assessed via participant interview. RESULTS: Overall, 235 participants were randomized, and 224 were included in the per-protocol analysis (PBK, 112; OSS, 112). Successful bowel cleansing was achieved for 95.5% (107/112) in the PBK group, which was non-inferior to the OSS group (98.2%, 110/112) with a difference of -2.7% (one sided 97.5% confidence limit, -8.1%). The participants in the PBK group had fewer intraluminal bubbles (0.9% vs 81.3%, P < 0.001) and reported a lower incidence of nausea and vomiting, with better acceptance, taste, and willingness to repeat the regimen than those in the OSS group (all P < 0.05). CONCLUSION: The novel sulfate tablet, PBK-1701TC, was non-inferior to OSS with respect to bowel-cleansing efficacy and exhibited better safety and tolerability in adults undergoing colonoscopy.

Comparative effect of elicitors on the physiology and secondary metabolites in broccoli plants.

Elicitation is an economic and sustainable technique for increasing the content of secondary metabolites, mainly bioactive compounds, in plants grown for better human nutrition. The aim of this study was to compare the physiological responses (water relations and mineral nutrition) and the enrichment in glucosinolates (GLSs) and phenolic compounds of broccoli plants (Brassica oleracea L. var. italica) receiving different elicitation treatments. The treatments involved the priming of seeds with KCl and the exposure of plants to elicitors, including K2SO4 and NaCl solutions and foliar sprays of methyl jasmonate (MeJA), salicylic acid (SA), and methionine (Met). The physiological response of the plants in terms of root hydraulic conductance was improved by priming with KCl and elicitation with MeJA or Met. Foliar application of Met significantly increased the plant biomass and enhanced mineral nutrition. In general, all treatments increased the accumulation of indole GLSs, but K2SO4 and MeJA gave the best response and MeJA also favored the formation of a newly described compound, cinnamic-GLS, in the plants. Also, the use of Met and SA as elicitors and the supply of K2SO4 increased the abundance of phenolic compounds; K2SO4 also enhanced growth but did not alter the water relations or the accumulation of mineral nutrients. Therefore, although the response to elicitation was positive, with an increased content of bioactive compounds, regulation of the water relations and of the mineral status of the broccoli plants was critical to maintain the yield.

Sulfate and hydroxychloride trace minerals in poultry diets - comparative effects on egg production and quality in laying hens, and growth performance and oxidative stress response in broilers.

Two experiments investigated the effect of sulfate and hydroxychloride trace minerals (TM), Zn, Cu, and Mn, in laying hens and broiler chickens. In Expt. 1, Lohmann Brown pullets (total of 1,344) at 21 wk of age were used for a 24-wk experiment. Each of the two treatments had 32 replicates with 21 hens per replicate. At 45 wk of age, three eggs per cage were randomly selected and used for internal quality assessment. In Expt. 2, Ross 308 broilers (total of 1,080) were allocated to two treatments. Each treatment had 30 replicates with 15 chicks per replicate. On day 28, after weighing, three birds were randomly selected from 15 randomly selected pens per treatment. The birds were euthanized and blood was collected for analysis for uric acid, C-reactive protein and methylmalonic acid. Samples were also taken from pectoralis muscle of each chicken and analyzed for mRNA expression of protein synthesis or hydrolysis genes. On day 35, 7 birds per pen were used for carcass evaluation. In Expt. 1, egg weight was greater (P < 0.01) in birds receiving sulfate TM from week 16 (of experiment) onwards whereas the percentage of cracked eggs was lower (P < 0.01) in hens receiving hydroxychloride TM. Percentage hen-day production tended to be greater (P < 0.10) in hens receiving hydroxychloride TM in weeks 4 to 8 only. In Expt. 2, birds receiving hydroxychloride TM had greater (P < 0.05) weight gain and tended to have greater (P < 0.10) feed intake on day 35. Expression of the gene, PSMA1, was lower (P < 0.05) whereas plasma level of uric acid and methyl malonic acid tended to be lower (P < 0.10) in birds receiving hydroxychloride TM. It was concluded that hydroxychloride TM reduced egg loss in hens at peak production and that improved growth performance response in broilers can be partly explained by reduction in proteolytic activities in the pectoralis muscle and greater resilience to oxidative stress.

Molecular characteristics of polysulfated fractions from the green seaweed Caulerpa cupressoides and actions on thrombin generation in vitro

Caulerpa cupressoides produces sulfated polysaccharides (Cc-SPs) with serpin-dependent anticoagulant effect, but their actions on thrombin generation (TG) are unknown. This study aimed to partially characterize Cc-SPs and examine their potential as modulators of TG. Infrared analysis characterized extract containing three ulvan fractions (Cc-SP1, -SP2 and -SP3) separated by DEAEcellulose chromatography, with differences in the relative proportions of sulfate (10.99-18.38%) and total sugars (46.59-51.12%), without presenting proteins. Charge density patterns and nonSPs varying from 8 to > 100 kDa on agarose and polyacrylamide gel electrophoresis by sequential staining with toluidine blue and stains-all were also confirmed by gel permeation chromatography. The molecular weight of Cc-SP2 was not altered after treatment with 0.4 M HCl up to 5 h. Only Cc-SP2 altered the activated partial thromboplastin time (15 ± 0.3 IU) vs. heparin (193 IU) and abolished at high concentrations (> 4.1 μg) TG by intrinsic pathway in 60-fold diluted human plasma, while at 4.1 μg attenuated TG by 33.87% delaying the lag phase (32 min.) vs. control (28 min.). Cc-SP2 induced concentration-dependent TG in system without cephalin. Heparin abolished TG at 4.15-fold lower amount, but did not stimulate TG. Therefore, Cc-SPs express dual effects on thrombosis in vitro.

Comparison Between an Oral Sulfate Solution and a 2 L of Polyethylene Glycol/Ascorbic Acid as a Split Dose Bowel Preparation for Colonoscopy.

BACKGROUND/AIMS: This study aimed to compare the efficacy and tolerability of an oral sulfate solution (OSS) versus 2 L of polyethylene glycol/ascorbic acid (2L-PEG/Asc) for bowel cleansing before colonoscopy. METHODS: A prospective, single-center, single-blinded, noninferiority, randomized, controlled trial was performed. The primary outcome was the rate of successful bowel cleansing, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes were examination time, polyp, and adenoma detection rate (PDR and ADR), tolerability, and safety. Ease of use, palatability, intention to reuse, and satisfaction were evaluated using a questionnaire. RESULTS: A total of 187 participants were randomized to receive either OSS (n=93) or 2L-PEG/Asc (n=94). Successful bowel cleansing was achieved in 86.0% (80/93) of the OSS group, which was noninferior to the 2L-PEG/Asc group (88.3%, 83/94), with a difference of -2.3% by ITT analysis [95% confidence interval (CI) -12.0 to +7.4]. The withdrawal time of the OSS group was significantly shorter than that of the 2L-PEG/Asc group (11.8±5.2 vs. 14.3±8.5; P=0.016). Ease of use, palatability, intention to reuse, and satisfaction were similar between the 2 groups. Adverse events were also similar between the 2 groups. Mucosal erythema (4.3%) and aphthous lesions (2.1%) were found only in the 2L-PEG/Asc group. CONCLUSIONS: OSS was as effective as 2L-PEG/Asc for successful bowel cleansing and had acceptable tolerability. OSS is a promising and safe low-volume preparation alternative for colonoscopy. (Clinical trial registration number: NCT02761213.).

Safety and Efficacy of Low-Volume Preparation in the Elderly: Oral Sulfate Solution on the Day before and Split-Dose Regimens (SEE SAFE) Study.

Background/Aims: The use of a low-volume bowel cleansing agent is associated with a greater willingness to undergo repeat colonoscopy. Oral sulfate solution (OSS) is a recently approved low-volume agent; however, its efficacy and safety in the elderly population remain unclear. We aimed to evaluate the efficacy, safety, and acceptability of the OSS preparation, in comparison to those of a standard polyethylene glycol (PEG; 4 L) preparation, in elderly patients. Methods: A multicenter, randomized, investigator-blinded study was conducted. Participants were randomized to receive OSS or 4-L PEG with a split-dose regimen. Bowel cleansing efficacy was assessed using the Boston Bowel Preparation Scale (BBPS). Acceptance, satisfaction, and preparation-related symptoms were recorded. Additionally, blood parameters were analyzed for electrolyte abnormalities and nephrotoxicity. Results: A total of 193 patients were analyzed. No group differences in overall bowel cleansing efficacy were observed, with "adequate"preparations achieved in 95.9% (93/97) and 94.8% (91/96) of patients in the OSS and 4L PEG groups, respectively (p=0.747). However, mean BBPS scores for the entire (p=0.010) and right colon (p=0.001) were significantly higher in the OSS group than in the 4-L PEG group. The severity of clinical adverse events and frequency of acute kidney injury were similarly low, and no clinically meaningful electrolyte changes were identified. Self-reported scores regarding amount (p<0.001) and feeling (p=0.007), as well as overall satisfaction (p=0.001) and willingness to repeat the preparation (92.8% vs 67.7%, p<0.001), were significantly better in the OSS group than in the 4-L PEG group. Conclusions: In elderly individuals, OSS with a split-dose regimen has greater acceptability and comparable efficacy in bowel cleansing compared to 4-L PEG. (Clinical trials registration number: NCT03112967).

Effect of manganese preconditioning and replacing inorganic manganese with organic manganese on performance of male broiler chicks.

The effects of manganese (Mn) preconditioning, 96 h post-hatch followed by the replacement of inorganic Mn with different levels of organic Mn (5 to 21 D), on growth, tissue excreta Mn content, gene expression, and enzyme activity were evaluated. A total of 420 day-old male Cobb 500 broilers were divided into 2 groups. One group was fed a corn-soybean meal basal diet containing 17 mg of Mn/kg (preconditioning diet, MnPD); the second group was fed the non-preconditioning diet (NPCD), which was the MnPD supplemented with 60 mg of Mn/kg from manganese sulfate (MnSO4). On day 5, each group was divided into 5 subgroups and were randomly assigned to dietary treatments consisting of MnPD alone or MnPD supplemented with 12 or 60 mg Mn/kg Mn as MnSO4 or Mn proteinate (6 replicate cages of 6 birds). Broiler chicks that were fed the MnPD had lower (P ≤ 0.05) body weight gain (BWG) and G:F ratio when compared to those that were fed the NPCD for 4 D. Birds that were fed MnPD (1 to 4 D) and switched to MnPD supplemented with 60 mg/kg Mn (5 to 21 D) had lower (P ≤ 0.05) BWG compared to those that were fed NPCD (1 to 4 D) and switched to MnPD supplemented with 60 mg/kg Mn for 21 D. Excreta, tibia ash, liver, and heart Mn levels were increased (P ≤ 0.05) by supplemental Mn. The expression of jejunum divalent metal transporter-1 mRNA levels, as well as activities of plasma total super oxide dismutase and liver alanine transaminase, was not affected by MnPD or Mn source and levels. These results confirmed that feeding marginally deficient Mn diets to broiler chicks post-hatch does affect growth rate and tissue Mn concentration.