Intravenous iron therapy in renal failure: friend and foe?

Anemia is a common feature of chronic renal dysfunction and is associated with significant morbidity and mortality. Although acquired insufficiency of erythropoietin is virtually universal, iron deficiency is also a common contributor to the development of anemia. Iron replacement, in particular via the intravenous route, has become commonplace and results in improved hematocrits either on its own or in association with an erythropoiesis stimulating agent. However, intravenous iron is not without its potential complications. These include acute allergic reactions, iron overload, potentially accelerated cardiovascular disease and risk of infection. It is the purpose of this review to critically evaluate the available clinical and experimental evidence linking iron supplementation therapy with these complications.     

Intravenous iron: the iatrogenic kick to lose control over oxygen?

Effective erythropoiesis requires both erythropoietin and iron. Regular, intravenous iron supplements represent a standard adjuvant therapy for the treatment of anemia of chronic kidney disease. In this paper, the authors speculate upon potential deleterious effects of intravenous iron on cellular physiology in the setting of the increased oxidant burden of hemodialysis patients.     

Interventional strategies for haemodialysis fistulae and grafts: interventional radiology or surgery?

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Intravenous bisphosphonate therapy for osteoporosis: Where do we stand?

The use of oral bisphosphonates, particularly members of the aminobisphosphonate subclass, is well established for the treatment of osteoporosis. In a number of clinical settings, intravenous administration appears to be advantageous. However, current dosing and efficacy data are limited while definitive, long-term trials with some of these agents are ongoing. In this article, we review the available information and discuss the use of these drugs on that basis.     

Oxygen and reactive oxygen species in cartilage degradation: friends or foes?

OBJECTIVES: This review is focused on the influence of oxygen and derived reactive species on chondrocytes aging, metabolic function and chondrogenic phenotype. METHODS: A systematic computer-aided search of the Medline database. RESULTS: Articular cartilage is an avascular tissue, and consequently oxygen supply is reduced. Although the basal metabolic functions of the cells are well adapted to hypoxia, the chondrocyte phenotype seems to be oxygen sensitive. In vitro, hypoxia promotes the expression of the chondrogenic phenotype and cartilage-specific matrix formation, indicating that oxygen tension is probably a key parameter in chondrocyte culture, and particularly in the context of tissue engineering and stem cells transplantation. Besides the influence of oxygen itself, reactive oxygen species (ROS) play a crucial role in the regulation of a number of basic chondrocyte activities such as cell activation, proliferation and matrix remodeling. However, when ROS production exceeds the antioxidant capacities of the cell, an "oxidative stress" occurs leading to structural and functional cartilage damages like cell death and matrix degradation. CONCLUSIONS: This paper is an overview of the in vitro and in vivo studies published on the influence of oxygen and derived reactive species on chondrocyte aging, metabolic function, and the chondrogenic phenotype. It shows, that oxygen and ROS play a crucial role in the control of cartilage homeostasis and that at this time, the exact role of "oxidative stress" in cartilage degradation still remains questionable.     

Sex‐related differences in neuromuscular control: Implications for injury mechanisms or healthy stabilisation strategies?

Sex‐related differences in neuromuscular activation have been previously identified and are thought to be an underlying contributor to the ACL injury mechanism. During dynamic tasks evaluating the role of muscle action as it relates to joint stability is difficult since individual muscle contributions to force generation are confounded by biomechanical factors of movement. The purpose of this study was to examine sex‐related differences in knee muscle action during a weight‐bearing isometric exercise and identify the stabilising role of these muscles. Healthy young adults stood with their dominant leg in a boot fixed to a force platform. A force matching protocol required participants to modulate normalised ground reaction forces in various combinations of anterior‐posterior, medial‐lateral loads while maintaining a constant joint position. Normalised electromyographic data of eight muscles crossing the knee joint were displayed in polar plots. Patterns were quantified with an orientation analysis and mean activation magnitudes were computed. Females demonstrated symmetrical activation patterns with significantly greater activation in the rectus femoris (p = 0.037), lateral gastrocnemius (p = 0.012), and tensor fascia lata (p = 0.005) compared to males. High between‐subject reliability (ICC = 0.772–0.977) was observed across groups suggesting we have identified fundamental sex‐related differences in knee joint stabilisation strategies. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:310–317, 2014.     

Preischemic Iloprost Application for Improvement of Graft Preservation: Which Route is Superior in Experimental Pig Lung Transplantation: Inhaled or Intravenous?

BACKGROUND: Optimal allograft protection is essential in lung transplantation to reduce postoperative organ dysfunction. Although intravenous prostanoids are routinely used to ameliorate reperfusion injury, the latest evidence suggests a similar efficacy of inhaled prostacyclin. Therefore, we compared donor lung-pretreatment using inhaled lioprost (Ventavis) with the commonly used intravenous technique. METHODS: Five pig lungs were each preserved with Perfadex and stored for 27 hours without (group 1) or with (group-2, 100 prior aerosolized of iloprost were (group 3) or iloprost (IV). Following left lung transplantation, hemodynamics, Po(2)/F(i)o(2), compliance, and wet-to-dry ratio were monitored for 6 hours and compared to sham controls using ANOVA analysis with repeated measures. RESULTS: The mortality was 100% in group 3. All other animals survived (P < .001). Dynamic compliance and PVR were superior in the endobronchially pretreated iloprost group as compared with untreated organs (P < .05), whereas oxygenation was comparable overall W/D-ratio revealed significantly lower lung water in group 2 (P = .027) compared with group 3. CONCLUSION: Preischemic alveolar deposition of iloprost is superior to IV pretreatment as reflected by significantly improved allograft function. This strategy offers technique to optimize pulmonary preservation.     

Medication Safety: Does Intravenous Acetaminophen Promote Perioperative Hypothermia for Total Hip Arthroplasty?

As an effective antipyretic with a yet-unknown mechanism-of-action, intravenous (IV) acetaminophen use for total hip arthroplasties (THA) may worsen perioperative hypothermia when combined with the known hypothermia-inducing effects of general anesthesia (GA), affecting wound healing, recovery times, and patient satisfaction. This retrospective chart review of primary THA cases compared perioperative heat loss for patients who received IV acetaminophen with GA (group A, n = 74) to those receiving GA alone (group B, n = 197). All patients received forced-air warming blankets. Neuraxial anesthesia cases were excluded. No significant temperature differences existed between group A (–0.33°C, SD = 0.36) and group B (–0.30°C, SD = 0.34, P > 0.05). IV acetaminophen use for THA does not appear to promote hypothermia under general anesthesia.