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Revista de Gastroenterologia Del Peru :... 2020Adequate bowel preparation is one of the most important factors related to the yield of colonoscopy. Lowquality bowel preparation has been associated with lower adenoma... (Comparative Study)
Comparative Study Randomized Controlled Trial
INTRODUCTION
Adequate bowel preparation is one of the most important factors related to the yield of colonoscopy. Lowquality bowel preparation has been associated with lower adenoma detection rates and increased healthcare expenses. Bowel preparation is a major impediment to undergo colonoscopy since it is perceived as an unpleasant experience by patients.
OBJECTIVE
This study was aimed to assess tolerance and acceptability of the bowel preparation using either polyethylene glycol (PEG) or mannitol solution.
MATERIALS AND METHODS
We enrolled 140 patients with indications of screening for colorectal cancer or with suspected large bowel diseases. They received either mannitol solution or PEG as bowel preparation. Patients were asked to fill a questionnaire about the bowel preparation experience.
RESULTS
Patients perceived more burdensome the preparation with PEG than mannitol for the variables nausea overall experience, post-procedure discomfort, disagreeable flavor, volume ingested and cost (p<0.05). A similar tolerance was reported for abdominal pain, bloating and anal irritation (p>0.05). The acceptability was 82.9% and 71.4% in the Mannitol group and in the PEG group, respectively (p=0.10).
CONCLUSION
Acceptance of the bowel preparation between mannitol solution and PEG was comparable. However, mannitol was better tolerated by the patients in regard to most of the evaluated items.
Topics: Adult; Aged; Cathartics; Colonoscopy; Cross-Sectional Studies; Female; Humans; Male; Mannitol; Middle Aged; Outcome Assessment, Health Care; Patient Satisfaction; Polyethylene Glycols; Prospective Studies
PubMed: 32369460
DOI: No ID Found -
The European Respiratory Journal May 2022Recent randomised clinical trials in bronchiectasis have failed to reach their primary end-points, suggesting a need to reassess how we measure treatment response.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Recent randomised clinical trials in bronchiectasis have failed to reach their primary end-points, suggesting a need to reassess how we measure treatment response. Exacerbations, quality of life (QoL) and lung function are the most common end-points evaluated in bronchiectasis clinical trials. We aimed to determine the relationship between responses in terms of reduced exacerbations, improved symptoms and lung function in bronchiectasis.
METHODS
We evaluated treatment response in three randomised clinical trials that evaluated mucoactive therapy (inhaled mannitol), an oral anti-inflammatory/antibiotic (azithromycin) and an inhaled antibiotic (aztreonam). Treatment response was defined by an absence of exacerbations during follow-up, an improvement of QoL above the minimum clinically important difference and an improvement in forced expiratory volume in 1 s (FEV) of ≥100 mL from baseline.
RESULTS
Cumulatively the three trials included 984 patients. Changes in FEV, QoL and exacerbations were heterogeneous in all trials analysed. Improvements in QoL were not correlated to changes in FEV in the azithromycin and aztreonam trials (r= -0.17, p=0.1 and r=0.04, p=0.4, respectively) and weakly correlated in the mannitol trial (r=0.22, p<0.0001). An important placebo effect was observed in all trials, especially regarding improvements in QoL. Clinical meaningful lung function improvements were rare across all trials evaluated, suggesting that FEV is not a responsive measure in bronchiectasis.
CONCLUSIONS
Improvements in lung function, symptoms and exacerbation frequency are dissociated in bronchiectasis. FEV is poorly responsive and poorly correlated with other key outcome measures. Clinical parameters are poorly predictive of treatment response, suggesting the need to develop biomarkers to identify responders.
Topics: Anti-Bacterial Agents; Azithromycin; Aztreonam; Bronchiectasis; Humans; Mannitol; Quality of Life
PubMed: 34675045
DOI: 10.1183/13993003.00777-2021 -
ACS Applied Materials & Interfaces Jun 2020Although nanoscaled metal-organic frameworks (nanoMOFs) are promising drug carriers, their appropriate formulation remains almost unexplored and basically restricted to...
Although nanoscaled metal-organic frameworks (nanoMOFs) are promising drug carriers, their appropriate formulation remains almost unexplored and basically restricted to intravenous routes. Lungs, beneficiating from a large absorption surface and low enzymatic presence, are a very attractive target for both local and systemic delivery. However, pulmonary nanoMOF formulation is a pending and defying task. Thus, we propose a pioneer nanoMOF-based microsphere system as a potential platform for pulmonary administration. A biocompatible nanoMOF was successfully encapsulated in mannitol by a simple and continuous spray-drying technique. Upon intratracheal administration to rats, the resulting formulation, exhibiting optimal properties (., homogeneity, size, density, and spray-drying process yield), was able to release the intact nanoMOF carrier uniformly along the lungs, reaching the bronchioles and alveoli.
Topics: Administration, Inhalation; Animals; Dextrans; Drug Delivery Systems; Excipients; Mannitol; Metal-Organic Frameworks; Microspheres; Proof of Concept Study; Rats, Wistar; alpha-Cyclodextrins
PubMed: 32364369
DOI: 10.1021/acsami.0c07356 -
International Journal of Pharmaceutics Jun 2022In the current work, we aimed to deliver high dose of voriconazole (VRC) to lung through dry powder for inhalation (DPIs). Furthermore, the research tested the...
In the current work, we aimed to deliver high dose of voriconazole (VRC) to lung through dry powder for inhalation (DPIs). Furthermore, the research tested the hypothesis that drug nanocrystals can escape the clearance mechanisms in lung by virtue of their size and rapid dissolution. High dose nanocrystalline solid dispersion (NCSD) based DPI of VRC was prepared using a novel spray drying process. Mannitol (MAN) and soya lecithin (LEC) were used as crystallization inducer and stabilizer, respectively. The powders were characterized for physicochemical and aerodynamic properties. Chemical interactions contributing to generation and stabilization of VRC nanocrystals in the matrix of MAN were established using computational studies. Performance of NCSD (VRC-N) was compared with microcrystalline solid dispersion (VRC-M) in terms of dissolution, uptake in A549 and RAW 264.7 cells. Plasma and lung distribution of VRC-N and VRC-M in Balb/c mice upon insufflation was compared with the intravenous product. In VRC-N, drug nanocrystals of size 645.86 ± 56.90 nm were successfully produced at VRC loading of 45%. MAN created physical barrier to crystal growth by interacting with N- of triazole and F- of pyrimidine ring of VRC. An increase in drug loading to 60% produced VRC crystals of size 4800 ± 200 nm (VRC-M). The optimized powders were crystalline and showed deposition at stage 2 and 3 in NGI. In comparison to VRC-M, more than 80% of VRC-N dissolved rapidly in around 5-10 mins, therefore, showed higher and lower drug uptake into A549 and RAW 264.7 cells, respectively. In contrast to intravenous product, insufflation of VRC-N and VRC-M led to higher drug concentrations in lung in comparison to plasma. VRC-N showed higher lung AUC due to escape of macrophage clearance.
Topics: Administration, Inhalation; Aerosols; Animals; Dry Powder Inhalers; Humans; Mannitol; Mice; Particle Size; Powders; Voriconazole
PubMed: 35589006
DOI: 10.1016/j.ijpharm.2022.121827 -
Respiratory Research Nov 2021The mannitol test is an indirect bronchial challenge test widely used in diagnosing asthma. Response to the mannitol test correlates with the level of eosinophilic and... (Review)
Review
BACKGROUND
The mannitol test is an indirect bronchial challenge test widely used in diagnosing asthma. Response to the mannitol test correlates with the level of eosinophilic and mast cell airway inflammation, and a positive mannitol test is highly predictive of a response to anti-inflammatory treatment with inhaled corticosteroids. The response to mannitol is a physiological biomarker that may, therefore, be used to assess the response to other anti-inflammatory treatments and may be of particular interest in early phase studies that require surrogate markers to predict a clinical response. The main objectives of this review were to assess the practical aspects of using mannitol as an endpoint in clinical trials and provide the clinical researcher and respiratory physician with recommendations when designing early clinical trials.
METHODS
The aim of this review was to summarise previous uses of the mannitol test as an outcome measure in clinical intervention studies. The PubMed database was searched using a combination of MeSH and keywords. Eligible studies included intervention or repeatability studies using the standard mannitol test, at multiple timepoints, reporting the use of PD as a measure, and published in English.
RESULTS
Of the 193 papers identified, 12 studies met the inclusion criteria and data from these are discussed in detail. Data on the mode of action, correlation with airway inflammation, its diagnostic properties, and repeatability have been summarised, and suggestions for the reporting of test results provided. Worked examples of power calculations for dimensioning study populations are presented for different types of study designs. Finally, interpretation and reporting of the change in the response to the mannitol test are discussed.
CONCLUSIONS
The mechanistic and practical features of the mannitol test make it a useful marker of disease, not only in clinical diagnoses, but also as an outcome measure in intervention trials. Measuring airway hyperresponsiveness to mannitol provides a novel and reproducible test for assessing efficacy in intervention trials, and importantly, utilises a test that links directly to underlying drivers of disease.
Topics: Administration, Inhalation; Asthma; Bronchial Provocation Tests; Diuretics, Osmotic; Humans; Mannitol; Practice Guidelines as Topic
PubMed: 34743708
DOI: 10.1186/s12931-021-01876-9 -
Journal of Oral and Maxillofacial... May 2024The removal of the lower third molar is a routine procedure in oral surgery, yet it often leads to postoperative side effects, particularly inflammation. Despite various...
BACKGROUND
The removal of the lower third molar is a routine procedure in oral surgery, yet it often leads to postoperative side effects, particularly inflammation. Despite various interventions explored in prior studies, there is still a need for effective strategies, such as anti-inflammatory substances, to address postoperative side effects.
PURPOSE
The purpose of this study is to answer the following clinical question: Does the local injection of 0.9 M mannitol reduce postoperative pain, trismus, and swelling in patients undergoing bilateral symmetrically impacted mandibular third molar extraction?
STUDY DESIGN, SETTING, SAMPLE
This prospective, single-blind, split-mouth study at Hamadan Dental School involved 30 patients with bilateral symmetrically impacted mandibular third molars. Inclusion criteria were: no current medication, no anesthesia allergies, bilateral symmetrically impacted mandibular third molars, non-smokers, and the absence of systemic diseases. Exclusion criteria were: poor oral hygiene, alcohol/cigarette use, drug consumption, diabetes, systemic/gastrointestinal disorders, infection at the surgical site, lack of patient cooperation, and mannitol/anesthetic allergy.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE
The predictor variable was therapeutic injection, and it was grouped into two categories, 0.9 M mannitol solution or distilled water.
MAIN OUTCOME VARIABLE
The primary outcome variable was pain. Secondary outcomes are trismus, swelling, patient satisfaction, and analgesic consumption.
COVARIATES
Covariates included demographic information and operative details.
ANALYSES
Statistical analyses included repeated measures and paired t-tests with a significance level set at P < .05.
RESULTS
The study comprised 30 participants (mean age: 22.6 ± 3.59 years; 6 men, 24 women). In the test group, pain intensity significantly decreased from 5.30 on surgery day to 0.00, with subsequent values of 2.97, 1.30, 0.40, 0.17, and 0.03. The control group also decreased from 7.68 to 0.00, with values of 4.73, 2.67, 0.97, 0.23, and 0.07. The difference was statistically significant (P < .001). No significant swelling differences at T1, T3, T5, and T7 (P > .05). The intervention group had improved maximum mouth opening at T1, T3, T5, and T7 (P = .011) compared to the control group.
CONCLUSION AND RELEVANCE
Mannitol infiltration significantly reduces postoperative pain and trismus in impacted third molar surgery. This finding underscores the potential for improved patient comfort and recovery in this context.
Topics: Humans; Trismus; Molar, Third; Tooth, Impacted; Pain, Postoperative; Mannitol; Female; Male; Prospective Studies; Adult; Tooth Extraction; Single-Blind Method; Young Adult; Mandible; Pain Measurement; Adolescent
PubMed: 38387857
DOI: 10.1016/j.joms.2024.01.019 -
International Journal of Molecular... Sep 2020To ameliorate ischemia-induced graft injury, optimal organ preservation remains a critical hallmark event in solid organ transplantation. Although numerous preservation... (Review)
Review
To ameliorate ischemia-induced graft injury, optimal organ preservation remains a critical hallmark event in solid organ transplantation. Although numerous preservation solutions are in use, they still have functional limitations. Here, we present a concise review of a modified Histidine-Tryptophan-Ketoglutarate (HTK) solution, named HTK-N. Its composition differs from standard HTK solution, carrying larger antioxidative capacity and providing inherent toxicity as well as improved tolerance to cold aiming to attenuate cold storage injury in organ transplantation. The amino acids glycine, alanine and arginine were supplemented, N-acetyl-histidine partially replaced histidine, and aspartate and lactobionate substituted chloride. Several in vitro studies confirmed the superiority of HTK-N in comparison to HTK, being tested in vivo in animal models for liver, kidney, pancreas, small bowel, heart and lung transplantation to adjust ingredients for required conditions, as well as to determine its innocuousness, applicability and potential advantages. HTK-N solution has proven to be advantageous especially in the preservation of liver and heart grafts in vivo and in vitro. Thus, ongoing clinical trials and further studies in large animal models and consequently in humans are inevitable to show its ability minimizing ischemia-induced graft injury in the sequel of organ transplantation.
Topics: Alanine; Animals; Arginine; Cryopreservation; Glucose; Glycine; Humans; Liver; Mannitol; Organ Preservation; Organ Preservation Solutions; Organ Transplantation; Pancreas; Potassium Chloride; Procaine; Reperfusion Injury
PubMed: 32899772
DOI: 10.3390/ijms21186468 -
Versatile roles of sorbitol in higher plants: luxury resource, effective defender or something else?Planta Jun 2022Sorbitol metabolism plays multiple roles in many plants, including energy and carbon enrichment, effective defence against various stresses and other emerging specific... (Review)
Review
Sorbitol metabolism plays multiple roles in many plants, including energy and carbon enrichment, effective defence against various stresses and other emerging specific roles. The underlying mechanisms are, however, incompletely understood. This review provides the current state-of-the-art, highlights missing knowledge and poses several remaining questions. The basic properties of sugar alcohols are summarised and pathways of sorbitol metabolism, including biosynthesis, degradation and key enzymes are described. Sorbitol transport within the plant body is discussed and individual roles of sorbitol in different organs, specific cells or even cellular compartments, are elaborated, clarifying the critical importance of sorbitol allocation and distribution. In addition to plants that accumulate and transport significant quantities of sorbitol (usual producers), there are some that synthesize small amounts of sorbitol or only possess sorbitol metabolising enzymes (non-usual producers). Modern analytical methods have recently enabled large amounts of data to be acquired on this topic, although numerous uncertainties and questions remain. For a long time, it has been clear that enriching carbohydrate metabolism with a sorbitol branch improves plant fitness under stress. Nevertheless, this is probably valid only when appropriate growth and defence trade-offs are ensured. Information on the ectopic expression of sorbitol metabolism genes has contributed substantially to our understanding of the sorbitol roles and raises new questions regarding sorbitol signalling potential. We finally examine strategies in plants producing sorbitol compared with those producing mannitol. Providing an in-depth understanding of sugar alcohol metabolism is essential for the progress in plant physiology as well as in targeted, knowledge-based crop breeding.
Topics: Carbohydrate Metabolism; Mannitol; Sorbitol; Sugar Alcohols
PubMed: 35713726
DOI: 10.1007/s00425-022-03925-z -
International Journal of Occupational... Mar 2020Various indirect or direct airway challenge tests are used to measure nonspecific bronchial hyper-responsiveness (NSBHR). The evaluation of NSBHR in diagnosing...
OBJECTIVES
Various indirect or direct airway challenge tests are used to measure nonspecific bronchial hyper-responsiveness (NSBHR). The evaluation of NSBHR in diagnosing occupational asthma (OA) is performed, e.g., to monitor the specific inhalation challenge test (SICT). The aim of this study was to preliminarily compare the results of methacholine and mannitol inhalation challenge tests in SICT monitoring in bakers with work-related airway symptoms.
MATERIAL AND METHODS
Four bakery workers with a suspicion of OA underwent single-blind placebo-controlled SICTs involving workplace allergens, accompanied by the evaluation of NSBHR with mannitol and methacholine, both before and after SICTs. Clinical examinations, spirometry tests, skin prick tests (SPTs) to common aeroallergens and occupational allergens, as well as tests to determine serum specific IgE antibodies to occupational aeroallergens were also performed.
RESULTS
Positive SPTs results to occupational aeroallergens were found in all bakery workers, and specific IgE antibodies to flour were detected in 2 subjects. Three patients displayed positive SICT reactions. In all of these 3 patients, airway responsiveness to methacholine increased significantly. In 2 patients, airway reaction to mannitol was significant, whereas in 1 subject there was no increase in NSBHR after mannitol inhalation. The patient with a negative SICT result did not reveal any changes in NSBHR before and after the test, either to methacholine or mannitol.
CONCLUSIONS
The data obtained by the authors show that there is no clear correlation between the methacholine and mannitol inhalation challenge tests in SICT monitoring. Preliminary results indicate the need for further investigations to evaluate the usefulness of the mannitol challenge test in the diagnostics of OA. Int J Occup Med Environ Health. 2020;33(2):235-9.
Topics: Adult; Allergens; Asthma, Occupational; Bronchial Provocation Tests; Female; Humans; Male; Mannitol; Methacholine Chloride; Middle Aged; Single-Blind Method
PubMed: 32080681
DOI: 10.13075/ijomeh.1896.01459 -
Plant Physiology and Biochemistry : PPB Feb 2021Quercetin is one of the main flavonoids in the human diet and mainly found in different plant tissues, including seeds, flowers, leaves, stems, and roots. However, its...
Quercetin is one of the main flavonoids in the human diet and mainly found in different plant tissues, including seeds, flowers, leaves, stems, and roots. However, its biological function in plant tissues, especially in seeds, is unknown. In this study, the seed germination and subsequent seedling growth of Apocynum pictum and A. venetum under osmotic stress (400 mmol L mannitol) supplemented with 5 μmol L quercetin were evaluated after 7, 14, and 21 days of germination. Results showed that quercetin improved the germination percentage and seed vigor, as indicated by the higher germination energy, shoot length, root length, dry weight, fresh weight, and chlorophyll content in A. pictum and A. venetum seedlings under the mannitol compared with those under the mannitol alone. Quercetin decreased HO and O production and cell membrane damage, and mostly increased the gene expression of superoxide dismutase, peroxidase, catalase, chalcone synthase and flavonol synthase in A. pictum and A. venetum seedlings under the mannitol compared with those under the mannitol alone. In addition, the germination energy of A. pictum was 21.57% higher than that of A. venetum, and the gene expression of key enzymes in quercetin biosynthesis in A. pictum was mostly higher than that in A. venetum after 1 and 7 days of germination. These results indicated that quercetin was an effective anti-osmotic agent that alleviated the adverse effect of mannitol-induced osmotic stress on seed germination and seed vigor, and A. pictum seeds were more osmotic resistant than A. venetum seeds.
Topics: Apocynum; Germination; Hydrogen Peroxide; Mannitol; Osmotic Pressure; Quercetin; Seedlings; Seeds
PubMed: 33401201
DOI: 10.1016/j.plaphy.2020.12.025