Oral magnesium for relief in pregnancy‐induced leg cramps: a randomised controlled trial

Leg cramps are common in pregnant women. Currently, there is no standard treatment for pregnancy‐induced leg cramps. The objective of this study was to evaluate the therapeutic efficacy of oral magnesium in pregnant women with leg cramps. This double‐blinded, randomised, placebo‐controlled trial included 86 healthy pregnant women, 14–34 weeks of gestation who had leg cramps at least twice per week. The study period was 4 weeks. Eighty women completed the study. Forty‐one women were assigned to magnesium bisglycinate chelate (300 mg per day) and 39 women to placebo. Details of leg cramps were recorded before beginning the treatment and the fourth week of study. Outcome measure was the reduction of cramp frequency after treatment and cramp intensity measured by 100‐mm visual analogue scale. Fifty per cent reduction of cramp frequency was significantly higher in the magnesium group than the placebo group (86.0% vs. 60.5%, P = 0.007). The 50% reduction of cramp intensity was also significantly higher in the treatment group than in the placebo group (69.8% vs. 48.8%, P = 0.048). There were no significant differences between the two groups in terms of side effects such as nausea and diarrhoea. These results demonstrated that oral magnesium supplement can improve the frequency and intensity of pregnancy‐induced leg cramps. Therefore, oral magnesium may be a treatment option for women suffering from pregnancy‐induced leg cramps.     

Combined application of extended depth of field imaging, image stitching, and polarized microscopy techniques in identification of Spatholobus suberectus

Objective As traditional techniques for microscopic identification of Chinese medicines currently lack objective and high-quality reference images, here we developed a systemic procedure to be used in microscopic identification of Chinese medicines, which would lead to more objective, effective and accurate identification process. Methods Spatholobi Caulis (Jixueteng in Chinese) was used as the specimen in the development of such procedure. Jixueteng samples were microscopically examined in bright- and dark-field microscopy. Microscopic images were obtained by regular, EDF, and image stitching techniques. Results The microscopic images of the characteristics in pulverized Jixueteng were captured, thanks to EDF imaging and image stitching techniques which allowed the detailed and full sighting of each characteristic to be obtained simultaneously. Different layers in anatomical transverse section, including cork, phelloderm, cortex, phloem, cambium, xylem and pith, were distinctively observed. Moreover, by comparing images of bright- and dark-field microscopy, birefringent and non- birefringent components could readily be distinguished. Conclusion With application of the developed procedure, high-definition, panoramic, microscopic images were acquired, which could be used as the reference images for microscopic identification of Chinese medicines.     

Quality of life among liver transplantation patients

Background

Orthotopic liver transplantation (OLT) is the treatment of choice for end-stage disease. It offers a chance to return to an active and prolonged life. Recently, more attention is being paid to the health-related quality of life (HRQoL) of patients and their spouses or caregivers after OLT. The aim of this study was to analyze the pre- versus posttransplantation HRQoL of patients and their spouses or caregivers using generic and disease-specific health questionnaires.

Material and Methods

The study was performed between October 2010 and January 2011 using the Short Form-36 (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) to evaluate the HRQoL.

Results

Posttransplantation patients (N = 59, mean age 53.39 [range, 23 to 76] years, male 63.2%, female 36.8%) and their spouses and caregivers showed significantly better generic SF-36 HRQoL scores, namely, physical and social functioning, role limitations because of physical or emotional problems, bodily pain, vitality, as well as general and mental health compared with pretransplantation patients (N = 57, mean age 54.56 (range, 22 to 69) years, male 71.2%, female 28.8%). Similarly, the posttransplantation group showed significantly improved CLDQ scores in all domains: fatigue, activity, abdominal symptoms, systemic symptoms, emotional function, and worry.

Conclusion

OLT improved HRQoL of end-stage liver patients and their spouses or caregivers.     

Analysis of donor risk factors associated with graft outcomes in orthotopic liver transplantation

Background

In orthotopic liver transplantation (OLT), the critical shortage of organ donors is the reason for accepting marginal donors. Although the outcome of OLT does not entirely seem to have been affected by the use of such donors identification of predictive risk factors is challenging. This study sought to identify significant risk factors associated with graft outcomes in our institute.

Methods

We retrospectively analyzed donor-associated factors for recipients who underwent liver transplantation from January 2002 to December 2009 for displaying primary dysfunction (PDF) as primary nonfunction (PNF) and initial poor function (IPF).

Results

We examined 97 post-liver transplant patients (male:female 70:27) whose average age was 52.74 years. The majority of indications for OLT were hepatitis B and/or C cirrhosis, alcoholic cirrhosis, and hepatocellular carcinoma. The incidence of PDF was 31.9% (31/97) including 7.2% PNF (7/97) and 24.7% IPF (24/97), versus 68.1% (66/97) with immediate function. The donors last serum alanine aminotransferase value being more than 65 IU/L was the only risk factor for poor graft function (P = .034). Donor peak and last serum sodium were potential risk factors.

Conclusion

Although many factors including a high serum sodium level are associated with a marginal liver graft, Last donor alanine aminotransferase level was the only significant factor that predicted the PDF.     

Comparison of noninvasive scoring systems for the prediction of nonalcoholic fatty liver disease in metabolic syndrome patients

Over half of metabolic syndrome (MetS) patients have nonalcoholic fatty liver disease (NAFLD). To prevent its complications, standard routine screening is required, but the human-resource and budgetary implications need to be taken into consideration. This study compared the performances of 4 noninvasive scoring systems in predicting NAFLD in MetS patients. They were the fatty liver index, hepatic steatosis index, lipid accumulation product index, and nonalcoholic fatty liver disease in metabolic syndrome patients scoring system (NAFLD-MS).Scores were determined for 499 MetS patients, including 249 patients in a type 2 diabetes mellitus (T2DM) subgroup. Ultrasonography was used to diagnose NAFLD. The accuracies and performance of the scoring systems were analyzed using published cutoff values, and comparisons were made of their areas under receiver operating characteristic curves, sensitivities, specificities, positive and negative predictive values, and likelihood ratios.NAFLD was detected in 68% of the MetS patients and 77% of the MetS patients with T2DM. According to the areas under receiver operating characteristic curves, fatty liver index and hepatic steatosis index provided better performances in predicting NAFLD. NAFLD-MS provided the highest specificity of 99% among the MetS patients as a whole, and it provided even better accuracy with similar performance when applied to the subgroup of MetS patients with T2DM. The maximum cost avoidance from unnecessary ultrasonography was also reported by using NAFLD-MS. In terms of simplicity and ease of calculation, the lipid accumulation product index and NAFLD-MS are preferred.All 4 scoring systems proved to be acceptable for predicting NAFLD among MetS and T2DM patients in settings where the availability of ultrasonography is limited. NAFLD-MS provided the highest specificity and cost avoidance, and it is simple to use. All 4 systems can help clinicians decide further investigations.     

Outcome of Liver Transplantation in Hepatocellular Carcinoma Patients at Siriraj Hospital

Background

Liver transplantation (LT) is one of the standard treatments for hepatocellular carcinoma (HCC), and the outcomes have become better after introduction of strict patient selection, such as the Milan criteria. However, several expanded criteria, such as the University of California San Francisco (UCSF) criteria, have demonstrated similar survival outcomes. The aim of this study was to verify survival outcomes of LT for HCC at Siriraj Hospital.

Outcomes of Orthotopic Liver Transplantation in Non-malignant End-stage Liver Diseases

Background

Orthotopic liver transplantation (OLT) is an effective treatment for patients who have end-stage liver disease. The aim of this study is to compare outcomes of OLT in fulminant hepatic failure (FHF) and non-fulminant hepatic failure (non-FHF) patients.

Methods

A retrospective review of adult patients who underwent OLT for non-malignant end-stage liver diseases between 2002 and 2011 at Siriraj Hospital was performed. All explanted liver histopathology results were reviewed. The clinical factors and overall results of OLT were analyzed.

Results

Of the 137 patients, 72 patients had non-malignant diagnoses. Eleven patients were diagnosed with FHF, whereas 61 patients were in the non-FHF group. The most common indication for liver transplantation was chronic viral hepatitis. One- and 5-year survival rates (95% confidence interval) in the FHF group were 91% (51%–99%) and 91% (51%–99%), respectively, whereas those in the non-FHF group were 74% (61%–83%) and 66% (52%–77%), respectively. Multivariate cox regression analysis revealed no statistically significant difference of survival between both groups (P = .34).

Conclusions

The post-OLT outcomes in non-malignant patients were comparable between FHF and non-FHF groups in terms of survival. OLT remains the only therapeutic option for the FHF patients.     

Renal Dysfunction After Orthotopic Liver Transplantation

Background

Identification of risk factors of acute renal failure (ARF) after orthotopic liver transplantation (OLT) may avoid the development and attenuate the impact on patient outcome. Therefore, the incidence and risk factors of ARF after OLT at Siriraj Hospital were analyzed.

Methods

The study was retrospectively analyzed from the OLT patients at the Siriraj Hospital between January 2002 and December 2009. ARF was defined as an increased in serum creatinine level more than 1.5 times within the first week postoperation compared with the preoperative level.

Results

A total of 81 liver transplant patients were analyzed. The mean age was 52.45 years (range, 22 to 71) and there were 25 women (30.86%) and 56 men (69.14%). Indications for OLT were end-stage liver cirrhosis (n = 43, 53.09%), hepatocellular carcinoma (n = 36, 44.44%), and fulminant hepatic failure (n = 2, 2.47%). Fifty-eight patients (71.60%) developed ARF, and the perioperative mortality of these was 18.97%. The univariate analysis identified the presence of preoperative coagulopathy, prolonged intraoperative hypotension, more blood loss, and postoperative hypotension as the risk factors of ARF. By the multivariate analysis, prolonged intraoperative hypotension more than 30 minutes and presence of postoperative hypotension were the independent risk factors of ARF. During the intraoperative and postoperative periods, ARF group required more blood and blood components transfusion, longer intensive care unit stay, and higher in-hospital mortality. Seven patients (12.07%) in the ARF group required postoperative renal replacement therapy. Four patients (9.52%) developed chronic renal failure, and one of them required long-term hemodialysis.

Conclusions

ARF was a common complication after OLT, which caused increased morbidity and mortality. Although some patients required dialysis, most of them recovered normal renal function. Prolonged intraoperative hypotension and presence of postoperative hypotension were the independent risk factors of ARF after OLT.     

Early leptin intervention reverses perturbed energy balance regulating hypothalamic neuropeptides in the pre‐ and postnatal calorie‐restricted female rat offspring

Pre‐ and postnatal calorie restriction is associated with postnatal growth restriction, reduced circulating leptin concentrations, and perturbed energy balance. Hypothalamic regulation of energy balance demonstrates enhanced orexigenic (NPY, AgRP) and diminished anorexigenic (POMC, CART) neuropeptide expression (PN21), setting the stage for subsequent development of obesity in female Sprague‐Dawley rats. Leptin replenishment during the early postnatal period (PN2‐PN8) led to reversal of the hypothalamic orexigenic:anorexigenic neuropeptide ratio at PN21 by reducing only the orexigenic (NPY, AgRP), without affecting the anorexigenic (POMC, CART) neuropeptide expression. This hypothalamic effect was mediated via enhanced leptin receptor (ObRb) signaling that involved increased pSTAT3/STAT3 but reduced PTP1B. This was further confirmed by an increase in body weight at PN21 in response to intracerebroventricular administration of antisense ObRb oligonucleotides (PN2‐PN8). The change in the hypothalamic neuropeptide balance in response to leptin administration was associated with increased oxygen consumption, carbon dioxide production, and physical activity, which resulted in increased milk intake (PN14) with no change in body weight. This is in contrast to the reduction in milk intake with no effect on energy expenditure and physical activity observed in controls. We conclude that pre‐ and postnatal calorie restriction perturbs hypothalamic neuropeptide regulation of energy balance, setting the stage for hyperphagia and reduced energy expenditure, hallmarks of obesity. Leptin in turn reverses this phenotype by increasing hypothalamic ObRb signaling (sensitivity) and affecting only the orexigenic arm of the neuropeptide balance. © 2015 Wiley Periodicals, Inc.     

Delayed Calcineurin Inhibitor Introduction Without Antibody Induction in Liver Transplantation Is Safe and Helps Preserve Kidney Function

IntroductionAcute kidney injury (AKI) is common after liver transplantation and affects outcome after liver transplantation. Antibody induction is commonly used to reduce dose and/or to delay introduction of calcineurin inhibitor (CNI) but is very expensive. We propose a modified immunosuppressive protocol that delays administration of CNI for 48 to 72 hours without antibody induction. This study evaluates the results of our new protocol.Material and MethodsA retrospective case-control study was performed. Study patients had induction with steroid and mycophenolate mofetil without antibody induction, and CNI administration was delayed for 48 to 72 hours. Control patients received CNI and steroid induction without antibody induction, and CNI was continued posttransplant. AKI was defined as an increase in serum creatinine level of at least 1.5 times the pretransplant baseline within the first postoperative week.ResultsSixty liver transplant recipients from 2013 to 2015 were included in this study (30 in the delayed CNI group and 30 in the control group). The patient characteristics and intraoperative factors were comparable in both groups. AKI developed in 11 patients in the study group and in 20 patients in the control group (37% vs 66.7%; P = .02). There was no acute rejection observed in the first month in either group.ConclusionWe have demonstrated that delayed CNI introduction without antibody induction is safe and helps preserve kidney function. Antibody induction can be omitted safely in a delayed CNI introduction protocol to reduce the cost of liver transplantation without increasing the risk of acute rejection.