Academic literature on the topic 'Serum 25D'

25-Hydroxyvitamin D (25D) circulates bound primarily to serum vitamin D binding protein (DBP), with DBP showing higher binding affinity for 25D3 than 25D2. We therefore hypothesized that vitamin D2 (D2) promotes higher serum levels of unbound 25D (free 25D), with different functional responses, relative to vitamin D3 (D3). Week 3 C56BL/6 mice were placed on diets containing either D2 or D3 alone (both 1000 IU/kg). At week 8 and week 16, D2 mice had only 25D2 in circulation (26.6 ± 1.9 and 33.3 ± 4.4 ng/mL), and D3 mice had only 25D3 (28.3 ± 2.0 and 31.7 ± 2.1 ng/mL). At week 8 (44.5 ± 6.4 vs 62.4 ± 11.6 pg/mL, P < .05) and week 16 (78.4 ± 12.6 vs 95.5 ± 11.6), D2 mice had lower serum 1,25-dihydroxyvitamin D relative to D3 mice. By contrast, measured free 25D was significantly higher in D2 mice at week 8 (16.8 ± 0.65 vs 8.4 ± 0.63 pg/mL, P < .001) and week 16 (17.4 ± 0.43 vs 8.4 ± 0.44, P < .001). A two-way ANOVA of bone histomorphometry showed that week 8 D2 mice had significantly higher osteoclast surface/bone surface, eroded surface/bone surface, and mineral apposition rate compared with D3 mice. Osteoblast surface/bone surface was higher in week 8 D2 females but not week 8 D2 males. At week 16, D2 mice had significantly higher bone volume/total volume and trabecular number compared with D3 mice. Differences in bone phenotype were observed despite D2 mice reaching similar serum 25D levels and lower 1,25D levels compared with D3 mice. These data indicate that 25D2 binds less well to DBP than 25D3, with resulting higher levels of free 25D promoting differential effects on bone in mice exposed to D2 alone.

Abstract BACKGROUND 24,25-Dihydroxyvitamin D [24,25(OH)2D] is a metabolite of 25-hydroxyvitamin D (25D). Blacks frequently have low total 25D without manifestations of vitamin D deficiency, suggesting that total serum 25D may incorrectly reflect vitamin D status in different racial groups. The ratio of serum 24,25(OH)2D to 25D [vitamin D metabolite ratio (VMR)] represents a new candidate biomarker for vitamin D status. METHODS We measured 24,25(OH)2D3 and 25D3 by mass spectrometry in a random community cohort of black (n = 212) and white (n = 164) Americans to evaluate VMR as a marker for vitamin D status. We measured parathyroid hormone concentrations by immunoassay to compare VMR and 25D3 against a physiological indicator of vitamin D deficiency. RESULTS Serum 24,25(OH)2D3 strongly correlated with 25D3 in both black and white study participants (r = 0.90, P < 0.001 and r = 0.86, P < 0.001 respectively). Blacks had lower mean 25D3 than whites [17.0 (7.8) vs 27.5 (11.3) ng/mL; 42.4 (19.5) vs 68.6 (28.2) nmol/L, P < 0.001] and lower mean 24,25(OH)2D3 [2.1 (1.3) vs 3.6 (2.0) ng/mL; 5.1 (3.1) vs 8.7 (4.8) nmol/L, P < 0.001]. In contrast to total 25D3 concentrations, mean VMR values were similar in blacks and whites [11.9 (4.0) vs 12.5 (3.4), P = 0.16, respectively] and were negatively correlated with parathyroid hormone concentrations in both races (rs = −0.26, P < 0.001, and rs = −0.25, P < 0.001, respectively). CONCLUSIONS Our results provide further evidence that measurement of total 25D for assessment of vitamin D status in patients of African descent deserves reevaluation and suggest that alternative measures such as VMR should be considered.

Abstract Inadequate levels of serum total 25-hydroxyvitamin D (25D) in chronic kidney disease (CKD) are associated with an increased risk of secondary hyperparathyroidism (SHPT). Serum 25D can be difficult to raise sufficiently with vitamin D supplements (cholecalciferol or ergocalciferol) to effectively lower elevated parathyroid hormone (PTH) levels especially in overweight patients. Obesity is common in CKD and requires attention when vitamin D repletion is considered. Vitamin D supplements are fat-soluble molecules which accumulate in adipose tissue. They have low affinity for serum vitamin D binding protein and are poorly mobilized from adipose tissue into circulation for hepatic activation. Recent studies suggest that serum 25D levels of ≥50 ng/mL are necessary to produce significant PTH reductions in nondialysis patients. Data were analyzed from two identical randomized clinical trials investigating the efficacy and safety of treating adult nondialysis patients with extended-release calcifediol (ERC; n=285) or placebo (n=144) to see if ERC raised 25D to at least 50 ng/mL in all body weight categories, with subgroup analyses by race, gender and age. On enrollment, subjects had eGFR of ≥15 and <60 mL/min/1.73 m2, PTH ≥85 and <500 pg/mL, serum 25D ≥10 and <30 ng/mL, corrected serum calcium ≥8.4 and <9.8, serum phosphorus ≥2. 0 and <5. 0, absence of nephrotic range proteinuria (>3 mg/mg creatinine) and no history of parathyroidectomy or renal transplantation. These subjects had mean (SD) age of 65.4 (10.9) years, serum 25D at baseline of 19.6 (5.4) ng/mL, body weight of 97.8 (24.3) kg and BMI of 34.7 (7.9) kg/m2. Fifty percent were male, 64. 0% White, 32.9% African-American or Black, and 3.1% Other, and 20% were Hispanic. A total of 356 subjects completed a 20- to 26-week treatment period per-protocol and were included in the analysis. Enrolled subjects ingested a 30 mcg capsule of ERC (OPKO Pharmaceuticals, Miami) daily for 12 weeks followed by one or two capsules (30 or 60 mcg) daily for a 14 more weeks. Control subjects received matching placebo. Mean (SD) serum 25D remained unchanged with placebo treatment but rose progressively with ERC treatment to 67.1 (21.6) ng/mL (mean of weeks 20-26). The observed increases in serum 25D were inversely related to body weight but exceeded 50 ng/mL in all body weight categories, irrespective of race (White vs. African-American or black), gender or age (<70 vs. ≥70 years). Side effects observed at these levels were similar to placebo. These data showed that ERC successfully raised mean serum 25D to at least 50 ng/mL irrespective of body weight, race, gender or age. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Abstract Background Extended-release calcifediol (ERC) has been shown in randomized clinical trials to effectively and safely treat secondary hyperparathyroidism (SHPT) in adults with stage 3-4 chronic kidney disease (CKD) and vitamin D insufficiency when administered at 210 or 420 mcg per week (30 or 60 mcg/day), doses which gradually raise serum total 25-hydroxyvitamin D (25D) to mean steady-state levels of 50-56 ng/mL. Clinical Case A 41-year-old male Caucasian with end-stage renal disease (ESRD) requiring regular hemodialysis (HD) experienced an overdose during participation in a phase 2 study of ERC for treating SHPT. Medical history included hypertension, type II diabetes, glomerulonephritis, bilateral lower extremity edema, muscle cramps, pruritus, shortness of breath, sporadic hypercalcemia and hyperphosphatemia, and iron deficiency anemia. Treatment with ERC began at an incorrect dosage of 2,700 mcg per week (900 mcg per HD) for 10 weeks as the study coordinator misunderstood the protocol-specified dose of 900 mcg per week. A 2.5% calcium dialysate was used during the study. Serum 25D gradually increased from 19 to 339 ng/mL (32-100), serum total 1,25-dihydroxyvitamin D (1,25D) increased from 6.3 to 137 pg/mL (24-86), plasma iPTH decreased from 440 to 146 pg/mL (15-65), and corrected serum calcium (Ca) decreased from 9.3 to 9.1 mg/dL (8.6-10.4). The subject remained asymptomatic throughout. Discovery of the overdose was delayed due to limited monitoring access during the pandemic and occurred when the ERC supply was prematurely exhausted. A physical exam and retrospective review of study records were promptly undertaken with no abnormalities noted. ERC administration, after a 1-dose hiatus, resumed at the correct dose (900 mcg per week). Serum 25D decreased over the next 4 weeks to 251 ng/mL, 1,25D decreased to 46. 0 pg/mL, iPTH increased to 186 pg/mL, and Ca remained stable (9. 0 mg/dL). The subject completed the full 6-month treatment period without adverse events. Clinical Lessons Gradual elevation of serum 25D and 1,25D with ERC to high levels had no impact on serum Ca or adverse events in the described subject suggesting that hypercalcemia observed with other vitamin D therapies used during HD results from abrupt increases in these metabolites. Serum 1,25D normalized with 25D elevation despite the lack of functional kidneys, indicating that extra-renal 1,25D production can become sufficient to control increased iPTH in ESRD when serum 25D is elevated well above the current clinical practice target of 30 ng/mL. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Abstract Vitamin D is obtained in the body by food intake or by production from 7-dehydrocholesterol by exposure of the skin to ultraviolet B radiation. It is first metabolized in the liver to 25-hydroxyvitamin D (25D), which is a major circulating metabolite. In the kidney, 25D is subsequently metabolized to the hormonally active form, 1,25-dihydroxyvitamin D (1,25D), via 1α-hydroxylase encoded by the CYP27B1 gene. 1,25D has a cellular effect through the vitamin D receptor, which leads to calcium absorption in the gut, bone metabolism, and parathyroid function. A recent study showed that a low vitamin D status is common worldwide and is associated with various diseases including kidney, heart, and liver failure, secondary hyperparathyroidism, osteomalacia, inflammatory bowel disease, granuloma-forming disorders (sarcoidosis and tuberculosis), and cancer. Vitamin D deficiency also increases the risks of falls, fractures, bone loss, sarcopenia, leading to worse outcomes of illness severity, morbidity, and mortality. The 1,25D/25D ratio is considered to be a useful tool for diagnosis of ocular sarcoidosis; however, its clinical utility and relevance to pathophysiology of evaluation of the ratio 1,25D/25D which indicates vitamin D activation have remained unknown. To clarify the clinical usefulness of markers for vitamin D activation, 87 patients in whom serum 25D and 1,25D level was measured were retrospectively reviewed in the present study. Data for 79 patients (33 males and 46 females) were analyzed after exclusion of 8 patients taking vitamin D. The median serum 1,25D/25D ratio was significantly lower in males than in females: 4.1 (IQR: 2.3–5.8) x 10−3 versus 6.8 (3.0–9.8) x 10−3. However, individual levels of 25D and 1,25D were not different in males and females. The major categories of main disorders were endocrine (30.6 %), inflammatory (18.5 %), and bone-related (16.7 %) disorders. The ratios of serum 1,25D/25D had significant negative correlations with femoral dual energy X-ray absorptiometry % young adult mean (DEXA %YAM) (R=-0.35) and lumbar DEXA %YAM (R=-0.32). Significant correlations were found between 1,25D/25D ratio and serum levels of inorganic phosphate (R=-0.34), intact parathyroid hormone (R=0.64) and alkaline phosphatase (R=0.46) in all patients. Of interest, the 1,25D/25D ratio had gender-specific characteristics: the ratio had a significant correlation with age in males (R=0.49), while it had a significant correlation with body mass index (BMI) in females (R=0.34). Collectively, the results revealed that the ratio of serum 1,25D/25D as a marker for activation of vitamin D had relevance to clinical parameters, especially bone turnover, with gender-specific features. It is suggested that the existence of a gender-specific difference of aging males and obese females regarding the activation of vitamin D that is functionally linked to bone metabolism.

Abstract A quantitative method to measure the specific binding capacity for 25-hydroxyvitamin D (25D-binding capacity) is described that resembles the qualitative "T3-uptake" assay. Patient's serum or standard (10 microL) is mixed with 0.5 mL of reagent containing 0.5 mumol/L 25-hydroxyvitamin D [25(OH)D3] plus 3000 counts/min [3H]25(OH)D3. After 0.5 h at 37 degrees C, the samples are treated with dextran/charcoal on ice for 1 h and centrifuged. The radioactivity of the bound tracer in the supernate is counted. Calibration is linear to approximately 10 mumol/L. 25D-binding capacity in reference-group serum samples was 4.33 (0.58 SD) mumol/L. The relationship between the inverse of 25D-binding capacity and the free fraction of [3H]1,25-dihydroxyvitamin D3 [1,25(OH)2D3] measured by ultrafiltration isodialysis was essentially linear (r = 0.934, P < 0.0001). Given this relationship, the calculated free fraction of 1,25(OH)2D3 equals 4.88 x 10(-3)/25D-binding capacity. The 25D-binding capacity was significantly lower in newborn babies and in adults with liver disease, and was increased during pregnancy (P < 0.01 for each). This method is applicable to situations where the biologically available concentration of 1,25(OH)2D is of interest.

Background: Since vitamin D has an inhibitory function on ductal morphogenesis of the pubertal mammary gland, it may have a role in the development of gynecomastia. The aim of this study was to determine the effect of vitamin D deficiency on the development of pubertal gynecomastia. Methods: Serum 25-hydroxyvitamin D (25D) levels in 50 adolescents with pubertal gynecomastia and 54 healthy controls between the ages of 11 and 17 years were compared. Results: Mean 25D level was 14.03 ± 6.38 (5.0-32.5) ng/ml in the pubertal gynecomastia group and 15.19 ± 6.49 (5.0-33.2) ng/ml in the control group (p = 0.361). According to the vitamin D status classification of the American Academy of Pediatrics, 66% of the pubertal gynecomastia group was found to be deficient and 14% were insufficient. In the control group these values were 53.7% and 29.6%, respectively (p = 0.158). Conclusion: From our results we hypothesize that, rather than low serum levels of 25D, a dysregulation of the vitamin D signal pathway, vitamin D metabolism or vitamin D storage within the mammary tissue might be the contributing factors to the development of gynecomastia.

<b><i>Introduction:</i></b> The safety and efficacy of extended-release calcifediol (ERC) as a treatment for secondary hyperparathyroidism (SHPT) in adults with stage 3 or 4 chronic kidney disease (CKD) and vitamin D insufficiency (VDI) has been demonstrated in prospective randomized clinical trials (RCTs). ERC (Rayaldee^®) was approved by the Food and Drug Administration in 2016 on the basis of these prospective RCTs. The current retrospective study assessed the postlaunch data available with respect to ERC’s efficacy and safety in increasing serum 25-hydroxyvitamin D (25D) and reducing parathyroid hormone (PTH) in the indicated population. <b><i>Materials and Methods:</i></b> Medical records of 174 patients who met study criteria from 15 geographically representative United States nephrology clinics were reviewed for 1 year before and after initiation of ERC treatment. Enrolled subjects had ages ≥18 years, stage 3 or 4 CKD, and a history of SHPT and VDI. Key study variables included patient demographics, medication usage, and laboratory results, including serial 25D and PTH determinations. <b><i>Results:</i></b> The enrolled subjects had a mean age of 69.0 years, gender and racial distributions representative of the indicated population, and were balanced for CKD stage. Most (98%) received 30 mcg of ERC/day during the course of treatment (mean follow-up: 24 weeks). Baseline 25D and PTH levels averaged 20.3 ± 0.7 (standard error) ng/mL and 181 ± 7.4 pg/mL, respectively. ERC treatment raised 25D by 23.7 ± 1.6 ng/mL (<i>p</i> &#x3c; 0.001) and decreased PTH by 34.1 ± 6.6 pg/mL (<i>p</i> &#x3c; 0.001) with nominal changes of 0.1 mg/dL (<i>p</i> &#x3e; 0.05) in serum calcium (Ca) and phosphorus (P) levels. <b><i>Discussion/Conclusion:</i></b> Analysis of postlaunch data confirmed ERC’s effectiveness in increasing serum 25D and reducing PTH levels without statistically significant or notable impact on serum Ca and P levels. A significant percentage of these subjects achieved 25D levels ≥30 mg/mL and PTH levels which decreased by at least 30% from baseline. Dose titration to 60 mcgs was rarely prescribed. Closer patient monitoring and appropriate dose titration may have led to a higher percentage of subjects achieving an increase in 25D levels to at least 50 ng/mL and a reduction in PTH levels of at least 30%.

Abstract We have previously demonstrated that innate (Toll-like receptor 2/1) and adaptive (IFN-γ) immune signals converge on a common vitamin D-dependent antimicrobial pathway in the human macrophage against Mycobacterium tuberculosis, including activation of CYP27B1 which converts 25D into the active 1,25D hormone as well as expression of antimicrobial peptides cathelicidin and human beta defensin 4. This antimicrobial activity is dependent on the level of extracellular 25D in culture. Therefore, we asked if this antimicrobial response could be recapitulated using sera from 25D deficient subjects before and after vitamin D repletion of the host in vivo. Serum has been collected prospectively from 67 Hispanic/Latino, 12 black and 21 non-Hispanic white, vitamin D-insufficient/deficient (8-29 ng/ml) before and after treatment with 500,000 IU vitamin D3. The mean total serum 25D in all three ethnic groups was 20ng/ml before and rose significantly (p&lt;0.001) after vitamin D3 repletion, with a mean fold-change of 2.0, 2.9 and 3.0 in white, Hispanic and blacks, respectively. Despite the most substantial rise in total 25D in the minority populations, the ability of the sera from white donors to increase IFN-γ-stimulated macrophage cathelicidin was 3-fold (p&lt;0.01) and 2-fold greater (p&lt;0.05) than in cells conditioned in African and Hispanic/Latino American sera, respectively. These data suggest an ethnic/racial disparity in response to vitamin D supplementation.

Chronic kidney disease (CKD) is a major non-communicable disease associated with high rates of premature morbidity and mortality. The prevalence of hypovitaminosis D (deficiency of 25(OH)D or 25D) is greater in racial/ethnic minorities and in patients with CKD than the general population. Low 25D is associated with bone and mineral disorders as well as immune, cardiometabolic and cardiovascular (CV) diseases. Thus, it has been suggested that low 25D contributes to the poor outcomes in patients with CKD. The prevalence of hypovitaminosis D rises progressively with advancing severity of kidney disease with over 30% of patients with CKD stage 3 and 70% patients with CKD stage 5 estimated to have low levels of 25D. This report describes several of the abnormal physiologic and counter-regulatory actions related to low 25D in CKD such as those in oxidative stress and inflammatory systems, and some of the preclinical and clinical evidence, or lack thereof, of normalizing serum 25D levels to improve outcomes in patients with CKD, and especially for the high risk subset of racial/ethnic minorities who suffer from higher rates of advanced CKD and hypovitaminosis D.

Dr Wyatt’s study investigated the complex relationship between vitamin D and melanoma, specifically if vitamin D status is associated with more aggressive melanomas. Exposure to solar ultraviolet radiation is the principal risk factor for melanoma and also the main source of vitamin D. This research found that insufficient vitamin D at time of melanoma diagnosis is significantly associated with poorer prognosis (as defined by tumour thickness). These results will contribute to a more refined public health message concerning melanoma and vitamin D, particularly in Queensland, which has the highest global incidence of melanoma, but vitamin D deficiency is not uncommon.

The magnetic nanocomplex (MNC) comprised of Fe3O4 nanoparticles (NP) and doxorubicin (DOXO) with a saturation magnetic magnetic moment m3 = 10.5 emu/g during magnetic nanotherapy initiated greater antitumor effect than MNC with m3 = 8.55 emu/g. After treatment of Walker 256 tumor the concentration of iron ions in the blood serum of animals with tumor increased and did not depend on the magnetic properties of MNC.

Adequate vitamin D status plays an important role in bone health and may also protect against Type 1 Diabetes (T1D), multiple sclerosis and certain cancers. Vitamin D is obtained from two sources; diet and through skin synthesis through the action of ultraviolet (UV) light. Dietary intakes of vitamin D are low in New Zealand (NZ) and the majority of our vitamin D comes from UV exposure. The NZ population may be at risk of low vitamin D status because of low dietary intakes, the country�s latitude (35-46 �S), and high proportion of darker skinned Maori and Pacific People. While case reports have described the occurrence of rickets, predominantly in immigrant groups, there are currently no national data on the vitamin D status of the NZ population. Reports of low vitamin D status in countries of similar latitude to NZ justify an examination of New Zealanders� vitamin D status. The best method to assess of vitamin D status is to measure circulating 25-hydroxyvitamin D concentrations. This thesis comprises three main studies. The first two had the following aims: to measure 25-hydroxyvitamin D concentrations and their determinants in a national sample (n=1585) of NZ children aged 5-14 y and to measure serum 25-hydroxyvitamin D concentrations and their determinants in a national sample (n=2948) of New Zealanders aged 15 y and over. The 2002 Children�s Nutrition Survey CNS02 was a year long (December, March-November) cross-sectional survey of a nationally representative sample of NZ school children 5-14 y. Over-sampling of Maori and Pacific children allowed ethnic specific analyses. The 1997 National Nutrition Survey (NNS97) participants were recruited over one year according to an area-based sampling frame with a 3 stage stratified design consisting of primary sampling units, households within each unit, and one randomly selected respondent from each household. Mean (99% CI) serum 25-hydroxyvitamin D concentrations were similar in children and adults (both 50 nmol/L). Among Maori, Pacific and NZEO children respectively, prevalence (%, 99% CI) of serum 25-hydroxyvitamin D deficiency (< 17.5 nmol/L) was 5% (2, 12), 8% (5, 14), and 3% (1,7). Based on a cutoff of < 37.5 nmol/L, prevalence of insufficiency was 41% (29, 53), 59% (42, 75) and 25% (15, 35), respectively. Based on a cutoff of 50 nmol/L, 56% of children were insufficient. Three percent of adult New Zealanders had serum 25-hydroxyvitamin D concentrations indicative of deficiency ([less than or equal to] 17.5 nmol/L); 48% and 84% were insufficient based on cutoffs of [less than or equal to] 50 and [less than or equal to] 80 nmol/L The main determinants of vitamin D status in NZ children were season, ethnicity and sex. After adjustment for other factors and covariates, boys had an adjusted mean (99% CI) 25-hydroxyvitamin D concentration 5 (1, 9) nmol/L higher than girls, Maori children were 7 (2, 11) and Pacific children 15 (11, 20) nmol/L lower than NZ European and Other (NZEO) children. Obese children were 7 (2, 11) nmol/L lower than overweight or �normal� weight. Children�s mean 25-hydroxyvitamin D concentrations (adjusted for other variables) peaked in March (69 nmol/L) and was at its lowest in August (36 nmol/L). In adults, there were effects of a similar magnitude of ethnicity and season on serum 25-hydroxyvitamin D concentrations. Obesity, latitude and age were determinants of vitamin D status in women but not men. Obese (BMI > 30) women had an adjusted mean vitamin concentration 6 (3, 10) nmol/L lower than women with BMI < 25. Women living in the South Island were 6 (3, 9) nmol/L lower than women living in the North Island. Additionally, adjusted mean serum 25-hydroxyvitamin D was 13 (8, 18) higher in women 15 -18 y than women 65 y or older. The third and final study aimed to determine whether the higher rates of vitamin D inadequacy reported in the winter than summer months in NZ also result in higher PTH concentrations, which would provide evidence for functional effect of inadequate vitamin D status. We also aimed to objectively explore the effect of natural skin colour on vitamin D status, given the higher prevalence of vitamin D insufficiency in dark-skinned groups living far from the equator. Skin colour measurements were taken with a hand-held light reflectometer (Datacolor Mercury[TM] 1000 colorimeter, Lawrenceville, NJ). In the 342 residents of Invercargill and Dunedin, mean serum 25-hydroxyvitamin D concentrations were lower in the late summer versus early spring (79 vs 51 nmol/L; P< 0.001). The lower serum 25-hydroxyvitamin D in early spring versus summer was associatedwith a 2 pg/mL (P< 0.001) higher parathyroid hormone (PTH) concentration. Interestingly, no significant effect of natural skin colour, based on light reflectance at the inside of the upper arm, was discovered, though there was a positive effect of tanning, based on light reflectance at the upper forearm, on serum 25-hydroxyvitamin D concentrations. Ethnicity and season are major determinants of serum 25-hydroxyvitamin D in New Zealanders. There is a high prevalence of vitamin D insufficiency in NZ children and adults, which may contribute to increased risk of osteoporosis and other chronic disease. While there is a pressing need for more convincing evidence with regards to the health risks associated with the low vitamin D status in children, evidence from the study of adults, where higher PTH concentrations were found during spring versus summer, suggests that the low 25-hydroxyvitamin D concentrations are having an adverse effect on bone health of adults. The high prevalence of vitamin D insufficiency in New Zealanders, warrants serious consideration of strategies such as fortification, to improve the vitamin D status of the population.

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Objectives: In this study, we investigated the relationship between serum vitamin D status and the prevalence of musculoskeletal pain among individuals on statin therapy. We hypothesized that lower serum vitamin D concentration would be associated with a higher odds of self-reported musculoskeletal pain among statin users. Background: HMG-CoA reductase inhibitors, or statins, are widely used lipid-lowering drugs that significantly reduce morbidity and mortality associated with heart disease. Statin use is associated with a higher prevalence of self-reported musculoskeletal pain in the general population. Non-blinded studies have shown improvement in statin-associated myalgia symptoms and increased tolerance to statin therapy after treatment of vitamin D deficiency. Methods: We performed secondary data analyses using the National Health and Nutrition Examination Survey (NHANES) 2001-2004. Employing SAS and SUDAAN, we carried out logistic regression to evaluate whether vitamin D deficiency modified the relationship between statin use and musculoskeletal pain. Based on a priori assumptions, we adjusted for the effects of demographics, selected disease states, and health habits in the logistic regression model. We also explored concentration-related trends of the effect of vitamin D on musculoskeletal pain. Results: Among 5941 participants age 40 years and older, the mean serum vitamin D concentration was 23.5 ng/mL [95% Confidence Interval (CI) 22.4, 24.2]. There was no significant difference in the mean serum vitamin D concentration between statin users (23.3 ng/mL, 95% CI 22.3, 24.3) and non-statin users (23.5 ng/mL, 95% CI 22.8, 24.2). Statin users had higher odds [adjusted odds ratio (aOR) 1.57, 95% CI 1.15, 2.13)] of self-reported musculoskeletal pain in any area (specifically including the lower extremities, lower back, upper extremities, and upper back) compared with non-users. Vitamin D deficiency was not a predictor of musculoskeletal pain (aOR 0.95, 95% CI 0.70, 1.28) in the overall sample. However, we found vitamin D deficiency to have a significant interaction with statin use for the outcome of musculoskeletal pain (p for interaction = 0.01). After stratifying the sample according to statin use, we found that compared to statin users with a vitamin D concentration of 15 ng/mL or higher, those using statins with vitamin D concentration less than 15 ng/mL demonstrated substantially higher odds of musculoskeletal pain (aOR 2.56, 95% CI 1.25, 5.25). Assessment of vitamin D as a continuous variable did not reveal a concentration-related trend between increasing vitamin D concentrations and musculoskeletal pain (p for trend = 0.4). Conclusions: After controlling for multiple confounders, our analyses showed that serum vitamin D concentration less than 15 ng/mL was associated with musculoskeletal pain among statin users. However, among those not using statins, no association between serum vitamin D levels and self-reported musculoskeletal pain was demonstrated. We showed that vitamin D deficiency modifies the relationship between statio use and musculoskeletal pain. Treating vitamin D deficiency has other proven benefits including, bone health and skeletal muscle function. Our data suggests it may be reasonable to identify and treat vitamin D deficiency in patients who report musculoskeletal pain, using statins.

Background: Contribution of dietary sources to vitamin D status is not clearly known. Some studies have shown that dietary intake of certain vitamin D rich foods had a significant positive influence on serum 25-hydroxyvitamin D [25(OH)D] concentrations, whereas other studies have shown no effect. Although sunlight exposure is a major source of circulating serum 25(OH)D, children and adolescents have been advised on the dangers of sun exposure. Diet may therefore be an important contributor of circulating serum 25(OH)D in absence of or reduced sunlight exposure. Objective: The aim of this study was to determine whether serum 25(OH)D concentrations were associated with any specific dietary patterns in US children and adolescents using assay-adjusted serum 25(OH)D data from National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006. Methods: Data from 2 cycles of the NHANES 2003-2004 and 2005-2006 for individuals aged 2 to ≤19 y, were used to study the association between dietary patterns and serum 25(OH)D. Dietary patterns were established using factor analysis based on food-frequency questionnaire data. Eigenvalues and Scree plot were used to derive 2 major principal factors. They were labeled as High Fat Low Vegetable (HFLV) and Prudent dietary patterns. Results: Serum 25(OH)D was significantly lower in HFLV dietary pattern group compared to Prudent dietary pattern group (25.1 vs 27.0 ng/mL; P=0.001). The highest serum 25(OH)D concentrations for all subjects were in the low-intake HFLV group or medium and high-intake Prudent groups (P=0.003 and P=0.012, respectively). In multivariate adjusted analysis, children with higher Prudent dietary contribution scores to overall diet showed a significant positive relation with serum 25(OH)D (β=62.01, P=0.016). When data were stratified by sex, a significant positive relation was observed in girls who consumed the Prudent diet (β=86.34, P=0.014) and a significant negative relation was observed in girls who consumed the HFLV diet (β=-84.32, P=0.022). Conclusion: Overall, serum 25(OH)D concentrations were associated with Prudent dietary pattern but not with HFLV dietary pattern in US children and adolescents. When stratified by sex, the relation between dietary patterns and serum 25(OH)D was confined to only girls. Children consuming HFLV pattern diet may benefit from vitamin D supplementation and sunlight exposure (outdoor activities), and should be encouraged to consume more vitamin D fortified foods.

Purpose: National prevalence of childhood overweight and obesity has plateaued in recent years, but rates remain high, with approximately 10% among children“high weight.” The relationship between adiposity and serum 25-hydroxyvitamin D [25(OH)D] status has been well-explored in older individuals, with inconsistent results. Furthermore, previous studies have suggested a relationship between adequate consumption of calcium and vitamin D and healthy weight status in older children and adults. However, in the infant population, there are few studies detailing the interaction between body composition and serum 25(OH)D or intake of calcium and vitamin D. Our study aims were to assess the association between serum 25(OH)D and body composition and to examine the association between adiposity and dietary intake of calcium and vitamin D in a sample of infants and toddlers. Methods: Our population included healthy male and female infants and toddlers from Pittsburgh, PA who participated in the “Practices Affecting Vitamin D Status in Pittsburgh Infants and Toddlers” study. Parents completed a Vitamin D and Sunlight Exposure Questionnaire, which assessed dietary intake of foods high in calcium and vitamin D as well as daily sunlight exposure (≥2 hours vs. >2 hours). Anthropometric measures and bloodwork for serum 25(OH)D were obtained during at the time of the study visit. Weight-for-length (WFL) percentile status was determined using WHO growth standards (low weight97.7 %ile) and WFL z-scores were calculated. ANOVA was used to compare mean serum 25(OH)D and calcium and vitamin D intake by WFL status. Chi square analysis was used to evaluate the relationship between serum 25(OH) D status (deficient =/mL, insufficient = 12-20 ng/mL, sufficient >20 ng/mL), calcium intake status (sufficient = >700 mg), vitamin D intake status (sufficient = >400 IU) and WFL percentile status. Pearson’s correlation coefficient was used to assess the strength and significance of associations between serum 25(OH)D, calcium and vitamin D intake and WFL z-score. The analysis was repeated after subdivision by race and sun exposure. Results: 125 infants and toddlers (9 to 24 months of age, 68% African American) participated in the study. Approximately 11% of the population had a high weight. Mean vitamin D intake (~600 IU/d) and median calcium intake (~1550 mg/d) exceeded recommendations. Prevalence of high weight was higher among children with adequate intake compared to those who consumed less than the recommendations (calcium: 41% vs. 36%, respectively; vitamin D: 45% vs. 29%, respectively). However, this difference was not statistically significant. Mean serum 25(OH)D level (37 ng/mL) was sufficient. When compared across WFL status, neither mean serum 25(OH)D nor mean intake of calcium and vitamin D varied significantly. No significant correlation was found between WFL and serum 25(OH)D for the cohort or any of the subgroups examined. Conclusions: Rates of infant overweight and obesity in our sample are similar in comparison with the national average. Our results do not support a relationship between calcium and vitamin D intake on weight status or an association between serum vitamin D and body composition in children of this age. Future studies are needed to re-examine these relationships in a larger group of children of more evenly distributed weight status.

Renal osteodystrophy (ROD) is a term that encompasses the various consequences of chronic kidney disease (CKD) for the bone. It has been divided into several entities based on bone histomorphometry observations. ROD is accompanied by several abnormalities of mineral metabolism: abnormal levels of serum calcium, phosphorus, parathyroid hormone (PTH), vitamin D metabolites, alkaline phosphatases, fibroblast growth factor-23 (FGF-23) and klotho, which all have been identified as cardiovascular risk factors in patients with CKD. ROD can presently be schematically divided into three main types by histology: (1) osteitis fibrosa as the bony expression of secondary hyperparathyroidism (sHP), which is a high bone turnover disease developing early in CKD; (2) adynamic bone disease (ABD), the most frequent type of ROD in dialysis patients, which is at present most often observed in the absence of aluminium intoxication and develops mainly as a result of excessive PTH suppression; and (3) mixed ROD, a combination of osteitis fibrosa and osteomalacia whose prevalence has decreased in the last decade. Laboratory features include increased serum levels of PTH and bone turnover markers such as total and bone alkaline phosphatases, osteocalcin, and several products of type I collagen metabolism products. Serum phosphorus is increased only in CKD stages 4-5. Serum calcium levels are variable. They may be low initially, but hypercalcaemia develops in case of severe sHP. Serum 25-OH-vitamin D (25OHD) levels are generally below 30 ng/mL, indicating vitamin D insufficiency or deficiency. The international KDIGO guideline recommends serum PTH levels to be maintained in the range of approximately 2-9 times the upper normal normal limit of the assay and to intervene only in case of significant changes in PTH levels. It is generally recommended that calcium intake should be up to 2 g per day including intake with food and administration of calcium supplements or calcium-containing phosphate binders. Reduction of serum phosphorus towards the normal range in patients with endstage kidney failure is a major objective. Once sHP has developed, active vitamin D derivatives such as alfacalcidol or calcitriol are indicated in order to halt its progression.

The effect of Dietary Electrolyte Balance (EB) in rations for growing and finished swine under high temperatures ambient was evaluated. Two hundred male castrated pigs with initial average 25,3±1.3 kg were allotted in completely randomized experimental design with five treatments T1 diet without supplemented electrolyte 191 mEq/kg; T2 (supl B) diet supplementd with sodium bicarbonate (NaHCO3) 250 mEq/kg; T3 (supl B+C) diet supplemented with (NaHCO3) and potassium chloride (KCl) 250 mEq/kg; T4 (supl B) diet supplemented with (NaHCO3) 300 mEq/kg; T5 (supl B+C) diet supplemented (NaHCO3) and (KCl) 300 mEq/kg and four replication and 10 pigs per experimental unit. The average weight of the animals was 68,8±3,4 kg. The performance parameters evaluated were the feed intake (FI), the daily gain (DG), finished weight (FW), nitrogen intake (NI), lysine intake (LI), efficiency of N utilization for weight gain (ENUWG), efficiency of L utilization for weight gain (ELUWG) and the gain:feed ration and physiologic parameters to respiratory frequency (RF) and rectal temperature (RT). Blood was colleted to measure serum concentration of Na, Cl and K. The average temperature was 29,65±1,80ºC with (RU) of 69,6±10,4%. The levels of EB decreased (P<0,05) the (FI) and improved (NI). The others performance parameters evaluated weren’t influenced by treatments (P>0,05). In the termination phase the supplementation with sodium bicarbonate and or potassium chloride with 250 or 300 mEq/kg can be used to correct electrolyte balance under heat stress.

In all patients with chronic kidney disease (CKD) stages 3–5, regular monitoring of serum markers of CKD-mineral and bone disorder, including calcium (Ca), phosphorus (P), parathyroid hormone (PTH), 25-hydroxyvitamin D, and alkaline phosphatase, is recommended. Target ranges for these markers are endorsed by guidelines. The principles of therapy for secondary hyperparathyroidism include control of hyperphosphataemia, correction of hypocalcaemia, use of vitamin D sterols, use of calcimimetics, and parathyroidectomy. of hyperphosphataemia is crucial and may be achieved by means of dietary P restriction, use of P binders, and P removal by dialysis. Dietary P restriction requires caution, as it may be associated with protein malnutrition. Aluminium salts are effective P binders, but they are not recommended for long-term use, as Aluminium toxicity (though from contaminated dialysis water rather than oral intake) may cause cognitive impairment, osteomalacia, refractory microcytic anaemia, and myopathy. Ca-based P binders are also quite effective, but should be avoided in patients with hypercalcaemia, vascular calcifications, or persistently low PTH levels. Non-aluminium, non-Ca binders, like sevelamer and lanthanum carbonate, may be more adequate for such patients; however, they are expensive and may have several side effects. Furthermore, comparative trials have failed so far to provide conclusive evidence on the superiority of these newer P binders over Ca-based binders in terms of preventing vascular calcifications, bone abnormalities, and mortality. P removal is about 1800–2700 mg per week with conventional thrice-weekly haemodialysis, but may be increased by using haemodiafiltration or intensified regimens, such as short daily, extended daily or three times weekly nocturnal haemodialysis. Several vitamin D derivatives are currently used for the treatment of secondary hyperparathyroidism. In comparison with the natural form calcitriol, the vitamin D analogue paricalcitol seems to be more fast-acting and less prone to induce hypercalcaemia and hyperphosphataemia, but whether these advantages translate into better clinical outcomes is unknown. Calcimimetics such as cinacalcet can significantly reduce PTH, Ca, and P levels, but they have failed to definitively prove any benefits in terms of mortality and cardiovascular events in dialysis patients. Parathyroidectomy is often indicated in CKD patients with severe persistent hyperparathyroidism, refractory to aggressive medical treatment with vitamin D analogues and/or calcimimetics. This procedure usually leads to rapid improvements in biochemical markers (i.e. significant lowering of serum Ca, P, and PTH) and clinical manifestations (such as pruritus and bone pain); however, the long-term benefits are still unclear.

♦ Major trauma results in a systemic stress response proportional to both the degree of initial injury (1st hit) and the subsequent surgical treatment (2nd hit).♦ The key physiological processes of hypoxia, hypovolaemia, metabolic acidosis, fat embolism, coagulation and inflammation operate in synergy during the days after injury/surgery and their effective management determines prognosis.♦ The optimal timing and method of long bone fracture fixation after major trauma remains controversial. Two divergent views exist between definitive early intramedullary fixation and initial external fixation with delayed conversion to an intramedullary nail once the patient’s condition has been better stabilised.♦ There is agreement that the initial skeletal stabilisation should not be delayed and that the degree of initial injury has a more direct correlation with outcome and the development of subsequent systemic complications rather than the method of long bone fracture stabilisation.♦ Trauma patients can be screened to identify those more ‘at risk’ of developing systemic complications such as respiratory insufficiency. Specific risk factors include: A high injury severity score; the presence of a femoral fracture; the combination of blunt abdominal or thoracic injury combined with an extremity fracture; physiological compromise on admission and uncorrected metabolic acidosis prior to surgery.♦ The serum concentration of pro-inflammatory cytokine interleukin (IL) 6 may offer an accurate method of quantifying the degree of initial injury and the response to surgery.♦ The effective management of the polytraumatised patient involves a team approach and effective communication with allied specialties and theatre staff. A proper hierarchy of the injuries sustained can then be compiled and an effective surgical strategy made.

Este manual (Parte I dos módulos de capacitação em Bases do diagnóstico microscópico da malária) ajudará os participantes durante seu treinamento em diagnóstico microscópico da malária humana. O manual foi concebido como base para um treinamento formal de quatro a cinco semanas de duração e destina-se a alunos com conhecimentos rudimentares de ciência. Ao concluir a capacitação, o aluno será responsável pelo diagnóstico de malária com lâminas de sangue de casos suspeitos na sua comunidade. Desse modo, decisões importantes referentes ao tratamento dependem da sua competência em garantir o diagnóstico de malária sem supervisão. Para ganhar a confiança do público e do sistema de saúde, a qualidade da formação desses agentes deve ser a mais alta possível e deve poder ser demonstrada. A estrutura do curso é “baseada em competências”, ou seja, apresenta informações técnicas essenciais para a aquisição de habilidades e instruções passo a passo em um formato facilmente compreensível. O treinamento é principalmente prático. Ao final do curso, os alunos devem demonstrar ter adquirido um alto nível de competência. A educação baseada em competências é uma maneira eficaz e comprovada para a aquisição das habilidades essenciais aos serviços públicos de saúde e de atenção à saúde. Além de capacitar os profissionais de saúde nos fundamentos do diagnóstico microscópico da malária, os módulos podem ser usados para a reciclagem de agentes já formados que realizam microscopia padrão da malária pelo método de Giemsa. Como esse pessoal já tem uma formação sólida e ampla experiência de trabalho, devem conseguir atingir os objetivos do curso em 11 ou 12 dias úteis. Para os laboratoristas e microscopistas de hospitais distritais ou estaduais/regionais já familiarizados com os procedimentos de laboratório, um curso mais curto pode ser benéfico, pois embora o diagnóstico microscópico da malária faça parte da rotina diária desses profissionais, os cursos de reciclagem ajudam a garantir a exatidão. Este manual está dividido em unidades de aprendizagem. As observações e instruções contidas em cada unidade são suficientes para reduzir ao mínimo possível a quantidade de anotações a serem tomadas pelos alunos, permitindo desse modo que participem plenamente das palestras e discussões. Ainda assim, há uma página em branco para anotações no final de cada unidade... Versão oficial em português da obra original em Inglês: Basic Malaria microscopy, 2nd ed (Part 1: Learner’s guide - Part 2: Tutor’s guide) © World Health Organization 2010. ISBN: 978-92-4-154782-6 (Part 1), 978-92-4-154791-8 (‎Part 2)‎.

Esta obra tem por objetivo apresentar produções acadêmicas que possuem em comum a grande área Ciências Agrárias. Permeando por este vasto tema, nas próximas páginas serão apresentados trabalhos que abordam sobre Ciência e Tecnologia de Alimentos, Engenharia Agrícola, bem como na Ciência Animal. Desta forma, para melhor direcionar o fluxo da leitura, o livro está dividido em capítulos, nos quais os primeiros apresentados abordam o tema “Ciência e Tecnologia em Alimentos” e apresenta trabalhos desenvolvidos com ênfase em controle de qualidade, aproveitamento de subprodutos e planejamento experimental. Acredito que o controle de qualidade de alimentos e o aproveitamento de subprodutos são temas de grande relevância para nosso país e desta forma, nós como professores e pesquisadores, devemos, por meio da ciência sempre trazer novas pesquisas a fim de preencher lacunas no conhecimento e apresentar novas possibilidades e soluções para o melhor aproveitamento e utilização dos alimentos. Na sequência, são apresentados trabalhos desenvolvidos na temática de produção e caracterização de forrageiras de cereais de inverno, predição da produtividade da cultura da soja por meio da aplicação de modelos de regressão linear, bem como relatar um estudo casos de onfalite em bezerros. Neste sentido, os trabalhos aqui apresentados, alinham-se a estas demandas e trazem novas analises que condizem com as necessidades emergentes da nossa sociedade. Profª. Drª. Heloisa Gabriel Falcão. Instituto Federal de Educação (IFG) – Campus Inhumas O crescimento da economia e da taxa de urbanização de alguns países, especialmente da Ásia, resultou em significativas mudanças no estilo de vida das populações neles residentes, com incrementos no consumo de bens duráveis, energia e alimentos. Além disso, estima-se que a população mundial ultrapassará 8,5 bilhões de pessoas até 2030 e que a maior porção desse crescimento demográfico ocorrerá na China, Índia e Indonésia. Esse contexto representa um desafio para a segurança alimentar e energética mundial, uma vez que, se as tendências atuais forem mantidas, a área agrícola deverá aumentar em cerca de 42 milhões hectares até 2027. Contudo, a limitação de terras agricultáveis permitirá um crescimento de apenas 10% em escala mundial, sendo que, quase metade disso se dará no Brasil e na Argentina. Assim, a América do Sul será a mais importante fonte de expansão agrícola do mundo. Com abundantes recursos naturais e grande potencial de desenvolvimento agropecuário, a América do Sul configura importante elemento estratégico para melhorar a segurança alimentar global. Em particular, o setor agropecuário brasileiro é reconhecido internacionalmente pela elevada inserção no mercado globalizado, com destaque para produção de carne de frango, açúcar, suco de laranja, fumo, café e soja... produtos do agronegócio brasileiro que são campeões no ranking de exportações do mercado global. Outros produtos agropecuários brasileiros que merecem grande destaque por configurarem entre as primeiras posições no ranking mundial de produção e exportação são: carne bovina, óleo de soja, farelo de soja, milho e leite bovino. A pandemia de Covid-19 impactou negativamente a economia mundial em razão das necessidades sanitárias e de distanciamento social. Ainda assim, mesmo em momentos de maiores restrições de circulação e transportes, vários segmentos agropecuários do Brasil experimentaram expressiva elevação na produção e vendas nacionais e internacionais. Isso ocorreu em razão das políticas preventivas de vários países no sentido de garantir a segurança alimentar de suas populações, restringindo as exportações e aumentando as importações de alimentos para ampliar suas reservas estratégicas. Essas políticas preventivas não foram adotadas pelo Brasil e, devido ao desmonte dos estoques reguladores e da redução substancial dos recursos destinados a agricultura familiar desde 2017, o mercado interno foi drasticamente afetado pelas exportações record de 2020 e 2021. A redução da quantidade de milho, soja e carnes, principalmente bovina, no mercado interno promoveu expressivo aumento dos preços num momento onde houve aumento de desemprego e queda de renda das classes menos abastadas da população brasileira. O Brasil, que já tinha voltado ao mapa da fome em 2018, sofreu um aumento de 14% no número de domicílios com algum tipo de insegurança alimentar entre 2018 e 2020. Estima-se que mais de 55% da população brasileira sofreu de insegurança alimentar entre 2020 e 2021, conforme dados da rede Penssan e da Organização das Nações Unidas. Nesse contexto, apesar das reduções dramáticas no volume de recursos públicos destinados a produção cientifica no Brasil, tornou-se ainda mais imprescindível a produção de pesquisas e a disseminação do conhecimento resultante delas. Composto por sete capítulos que apresentam pesquisas relevantes, esse livro pretende contribuir com subsídios significativos para o enfrentamento desse imenso desafio que se apresenta, ainda mais intenso nesses tempos de pós-Covid-19, que é elevar a eficiência da produção agropecuária a fim de garantir melhores condições de segurança alimentar para a população brasileira. O primeiro capítulo apresenta uma proposta de utilização da farinha de okara para o enriquecimento do hamburguer de carne bovina. Um dos produtos mais conhecidos do processamento da soja é o leite de soja ou extrato aquoso de soja. Ele é obtido a partir da lavagem, maceração, aquecimento e filtração dos grãos de soja. O okara é o subproduto solido do processo de filtração que separa o leite de soja. Aproximadamente, 250 g de farinha de okara são obtidos a partir do processamento de cada quilo de soja. Trata-se de um alimento altamente nutritivo, fonte de isoflavonas, antioxidantes, fibras solúveis e insolúveis que, além de auxiliar na redução de colesterol e triglicerídeos, previne a ação carcinogênica do bolo fecal. Os capítulos 2 e 3 apresentam um estudo que desenvolveu e avaliou as características químicas, físicas e funcionais de biscoitos, tipo cookie, com substituição parcial de farinha de trigo por farinha de gérmen de milho. Essa proposta se mostra extremamente relevante do ponto de vista econômico e nutricional. Uma vez que o advento do conflito bélico entre Rússia e Ucrânia tende a reduzir a oferta de trigo no mercado global e elevar seus preços. O Brasil é o segundo maior produtor de milho do planeta e apenas o 21º produtor de trigo. O resultado disso é que o Brasil importa cerca de 50% do trigo consumido no mercado interno. Além disso, o aumento da prevalência de pessoas com sensibilidade ao glúten, apontado pela pesquisa nacional de saúde do IBGE em 2017, torna esse tipo de experimento, muito relevante para o aumento de alternativas alimentares para esse público. O capítulo 4 compreende um estudo que identificou os agentes causadores de mastite em vacas leiteiras. Além disso, avaliou a relação entre a sua ocorrência de mastite e a qualidade do leite. A mastite é uma reação inflamatória da glândula mamária, geralmente associada à presença de microrganismos, que reduz a qualidade do leite e seus derivados, bem como a segurança do consumidor em razão de alterações na composição físico-química e sensorial dos produtos. Trata-se de uma pesquisa de grande relevância, uma vez que a retomada das exportações de leite para a China em 2021 tende a reduzir a oferta no mercado interno. Ainda sem as exportações para a China, o Brasil vendeu cerca de 29 milhões de toneladas de leite para Argélia, Venezuela, Estados Unidos, Argentina e Uruguai em 2021. Isso explica parte da pressão inflacionaria sobre o produto desde o início das medidas de contenção da Covid-19. Nesse contexto, contribuições que auxiliem na melhoria da qualidade e aumento da produtividade são salutares. O capitulo 5 nos relata um experimento que analisou as características químicas e bromatológicas de forragens de cereais de inverno em duas alturas de corte do solo e os benefícios da manutenção da cobertura vegetal na forma de matéria seca. Cereais de inverno, como centeio, trigo, triticale, cevada e aveia, além de produzirem grãos utilizados na alimentação humana, podem servir de alimento para aves, suínos, bovinos de corte, ovinos e, principalmente, vacas leiteiras. Na região Sul do Brasil, durante o inverno, não é incomum que grande parte de áreas agrícolas e máquinas fiquem ociosas. Dessa forma, a produção de cereais de inverno para forragear os rebanhos e para formar reservas para épocas de escassez parece ser uma estratégia viável para melhorar a constância da produtividade animal, gerando renda e diluindo os custos fixos da propriedade rural. Ademais, a manutenção de matéria seca no solo contribui para a redução de custos por meio da conservação da fertilidade do solo e redução da perda de carbono e necessidade de insumos. O sexto capítulo trata da utilização de técnicas de sensoriamento remoto para estimar a produtividade da cultura da soja, com a utilização de imagens de satélite. São apresentados modelos de regressão múltipla para prever a produtividade a partir de índices de vegetação (NDVI, SAVI, NDWI e EVI2). Ainda que pesquisas oficiais com as do IBGE e CONAB estimem a produtividade da soja com relativa precisão em escala estadual, elas são baseadas em abordagens qualitativas com grupos focais. Assim, o desenvolvimento de novas técnicas para o acompanhamento das culturas em escala microrregional pode contribuir para a redução de custos e maior precisão nas pesquisas oficiais. Além disso, os produtores e operadores do agronegócio podem fazer uso de insumos específicos para o planejamento da cultura e tomada de decisões. O capitulo 7, último desse livro, relata um estudo de 30 casos de onfalite em bezerros, dos quais 15 animais foram tratados conservadoramente e 15 submetidos ao tratamento cirúrgico. A onfalite constitui uma infecção dos remanescentes umbilicais cuja evolução pode resultar em óbito do animal ou comprometer o crescimento e rentabilidade do sistema produtivo desse. Os escassos estudos epidemiológicos brasileiros, a respeito dessa afecção umbilical, relatam que entre 21% e 45% dos bezerros neonatos desenvolverão algum nível dessa infecção e desses, entre 5,5% e 10% irão a óbito. Os resultados do estudo descrito nesse capítulo são extremamente relevantes para que criadores, zootecnistas e médicos veterinários tenham maios evidencias na tomada de decisão a respeito dos procedimentos a serem adotadas diante de tal situação. João Francisco Severo Santos. Doutor em Ciências do Ambiente – UFT. Analista de Pesquisas Agropecuárias - IBGE

Como será o lugar quando ninguém passa por ele? – pergunta o poeta. Será que “Existem coisas sem ser vistas?” E o mundo, mundo grande, como escreveu, pode existir “apenas pelo olhar que cria e lhe confere espacialidade?” O poeta parece querer nos dizer que “Aquilo que vemos vale – vive – apenas por aquilo que nos olha”, 1 que ver é experimentar ser visto, que ser visto é existir, e ainda que haja uma “cisão que separa dentro de nós o que vemos daquilo que nos olha”, 2 as coisas, os acontecimentos só têm existência na medida mesma de nossa presença, de nossa potência visual, de nosso corpo que toma e encorpa o espaço, o tempo e gera existência e resistência, presença e ausência, o antes e o depois, a perda e a insistência. Duas dimensões importantes de parte significativa da poética de Carlos Drummond de Andrade são a memória e a questão da finitude, que se manifestam em resíduos de memórias e de espaços familiares. A dimensão da finitude, em especial, faz com que o poeta some inúmeras questões em forma de perguntas à sua poética, como lemos na passagem do poema supracitado. Esse dado é importante porque denota a provisoriedade e a fragilidade das respostas possíveis elaboradas no corpo dos próprios poemas. O poeta não tem respostas para todas as perguntas que faz. Os historiadores também não têm respostas para todas as questões que levantam em suas pesquisas, em suas aulas, cursos, intervenções. Por isso, com relação a Drummond, parte de sua poesia é metapoesia. Nesse sentido, somos levados a nos perguntar se a escrita do Historiador não seria meta-história, ou seja, o “estudo referente à história enquanto historiografia; por exemplo, o estudo da linguagem, ou linguagens, da historiografia”? 3 Assim, dessa forma, elaboramos histórias que ajudam na construção de outras histórias? Cada um dos autores desta coletânea conhece o lugar por onde passam, porque sua prática é constituída por um demorar-se em suas temáticas, pela identificação e reflexão sobre problemas e questões, portanto, o desejo é que nada permaneça fora do alcance de sua vista, o que garante para cada um a criação e configuração de certa espacialidade e temporalidade fundamentais com relação às pesquisas abordadas. Evidentemente que demorar-se e conhecer-se, nas temáticas levantadas, não isenta todos, todas e cada um de certa estranheza e inquietação marcadas exatamente pelas respostas impossíveis de serem encontradas, assim é que a familiaridade com a temática não garante, e jamais garantirá, a tranquilidade de um “sentir-se em casa”, o que até certo ponto é bom, na medida em que nos coloca sempre em estado de alerta para o que até então não foi visto, alcançado, sentido como presença em variados tempos e espaços, e que esperam de nós inteligibilidade na busca, a um só tempo, pelo todo e as partes, como assevera Antoine Proust. Portanto, nada é suposto na existência, isso porque, como escreve o poeta, “Ou tudo vige planturosamente, à revelia/ de nossa judicial inquirição / e esta apenas existe consentida/ pelos elementos inquiridos?”, posto que o que vigora na existência, mesmo à revelia de nossa mais cuidadosa inquirição, o que garante as nossas questões, são as próprias questões, e não o que está fora, o que não faz parte das problemáticas levantadas, e é exatamente nessa “espantosa batalha/ entre o ser inventado/e o mundo inventor” que nos colocamos e nos demoramos. Somos “ficção rebelada/ contra a mente universa”, levantando a alvenaria de nosso lugar, de nosso estranho lugar, de nossa morada, lugar de uma certa permanência que nos ampara e nos sacode ao mesmo tempo. Assim, abrimos nossas trilhas em seu sétimo volume. Trilhas são caminhos ou estradas, existentes ou estabelecidos, com dimensões e formas, comprimento e largura diferentes, aptos a aproximar, juntar, estabelecer espaços de interação, indicar, duvidar, marcar, apontar direções, ligar, sinalizar, abrir passagens. Entre as inúmeras trilhas abertas sertões afora e cidades adentro, nós abrimos as nossas, dispomos nossos passos, medimos as dificuldades do terreno e nos lançamos nessa caminhada que já dura tantos anos, deixando fincados nas terras por onde passamos, marcos e marcas, impressões e signos, sinais e símbolos, partes de cada de um nós, como um olhar lançado, que confere e configura tempos e espacialidades. O presente volume divide-se em duas partes, respectivamente: “História, memória, autoritarismo e militância política no século XX” e “Experiências citadinas e sertanejas, oralidade e tradição nos sertões do Ceará nos séculos XIX e XX”. Na primeira parte do livro, abrimos nossos trabalhos com o capítulo de Jucelio Regis da Costa, “Da construção a celebração do golpe de 1964 no Ceará: usos políticos de elementos neomedievalizantes”, que faz uma análise de acontecimentos nacionais da década de 1960, com profundas repercussões no Ceará, como as Cruzadas do Rosário em Família, a Missa congratulatória às Forças Armadas e as Marchas da Vitória, com ampla mobilização política de grupos conservadores do estado, com a finalidade de combater o comunismo, servindo assim “na pavimentação do caminho ao golpe civil-militar de 1964”. O autor elege como objeto central de sua análise elementos neomedievalizantes, quando sentidos positivos foram atribuídos à Idade Média e os acontecimentos em questão foram medievalizados. Edvanir Maia da Silveira, em “Os partidos políticos e a experiência democrática na Zona Norte Cearense (1945-64)”, discute como as décadas de 1945 a 1964 consagraram-se na historiografia como tempo da experiência democrática, em que vigorava uma Constituição, partidos, eleições e participações sociais no debate político, sem, no entanto, descurar do fato de que muitas práticas autoritárias estavam presentes e ativas no cenário político, de modo que essas experiências e conflitos foram vivenciados e ressignificados pelas lideranças da Zona Norte do Ceará. O capítulo assinado por Viviane Prado Bezerra, “‘Quando a mulher sai do mundo da cozinha dela e começa a participar das coisas, então ela começa a ver o mundo diferente’: trabalho pastoral e atuação política das camponesas no Movimento do Dia do Senhor (1970-1990)”, aborda a militância religiosa e política de mulheres camponesas no Movimento do Dia do Senhor, uma iniciativa católica que tinha relação com as Comunidades Eclesiais de Base – CEBs e que teve intensa atuação entre as décadas de 1960 e 1990 alimentada pela dimensão da “fé e vida”, modificando “a visão de mundo e atuação dessas mulheres em suas comunidades”, tornando-as “protagonistas na luta pela libertação, posse da terra e pela igualdade de gênero”. No último capítulo da primeira parte, “Cem anos de comunismo no Brasil: onde Camocim entra nessa história?”, de Carlos Augusto Pereira dos Santos, o autor discute, dentro das comemorações dos cem anos do Partido Comunista do Brasil (PCdoB), agora em 2022, a participação da cidade de Camocim nessa longa história, utilizando como documento uma entrevista realizada com o “Sr. Nilo Cordeiro de Oliveira, comunista histórico em Camocim, filho de Pedro Teixeira de Oliveira (Pedro Rufino), um dos fundadores do Partido Comunista Brasileiro (PCB) em Camocim em 25 de março de 1928”. Voltando à trilha poética aberta por Carlos Drummond de Andrade, tomando o caminho dA suposta existência, pensamos se “A guerra sem mercê, indefinida, prossegue, feita de negação, armas de dúvida […]teima interrogante de saber/ se existe o inimigo, se existimos/ ou somos todos uma hipótese/ de luta/ ao sol do dia curto em que lutamos”, e se a nossa luta se faz e se refaz em cada página escrita, em cada aula debatida, em cada projeto realizado, uma vez que, se a pressa existe, é porque sabemos que um dia é muito curto para quem luta. Por isso a soma de todos nós, a multiplicação de nossas pesquisas, a publicização tão importante de nossas inquietações. Na segunda parte do livro, Francisco Dênis Melo, a partir do capítulo “Sobral e os seus altares: imaginária urbana e heróis civilizadores”, tem como objetivo “pensar a cidade de Sobral-CE a partir de alguns de seus habitantes de pedras, ou melhor, de sua imaginária urbana, no caso bustos, estátuas e monumentos destacados em variados espaços, notadamente em suas praças”, que funcionaram e ainda funcionam como anteparo para os campos políticos e religiosos na cidade, constituindo assim um poderoso mecanismo simbólico de construção do poder em Sobral. Thiago Braga Teles da Rocha, em “‘Sobral como cidade progressista’: entre planos, projetos e representações”, discute o processo de eletrificação em Sobral, estabelecendo uma relação com o conceito de progresso. O texto nos mostra que foi organizada uma “campanha em prol da eletrificação da cidade, realizada por setores da elite política da cidade, com destaque para a Igreja Católica a partir do jornal Correio da Semana”. Para isso, foi utilizado o “Projeto das Redes Primárias e Secundárias de Distribuição de Energia Elétrica da Cidade de Sobral”, documento resguardado no Núcleo de Documentação Histórica (NEDHIS), ligado ao curso de História da Universidade Estadual Vale do Acaraú. O capítulo assinado por Antônio Vitorino Farias Filho, “Imagens no espelho: mulher depravada e mulher ideal em Ipu-CE no início do século XX”, discute a questão da prostituição e sua relação tensa com a chamada Modernidade e com os valores do progresso, de modo que a prostituta no espaço público representou “uma imagem invertida da mulher ideal, buscada pelos grupos dominantes”. Chama atenção o autor para o importante fato de que “É somente no início do século XX, mais ainda na década de 1920, na cidade de Ipu, que a prostituta e a prostituição aparecem explicitamente nas fontes”. No capítulo “‘Isso é atestado de seu progresso. Sí Sobral, Camocim e outras cidades sertanejas têm o seu jornal, porque não poderíamos ter?’ a elite escritora e o ideário de controle e modernidade em Ipu-CE (1900-1920)”, Antonio Iramar Miranda Barros e Alexandre Almeida Barbalho discutem a questão da Modernização sob a ótica das lides jornalísticas, a partir das experiências e do “pensamento de três sujeitos, a partir dos grupos aos quais pertenciam: Abílio Martins, Herculano Rodrigues e Leonardo Mota”, entendendo que os jornais eram encarados como sinais claros de progresso, desenvolvimento e inovação. Raimundo Alves de Araújo e Emmanuel Teófilo Furtado Filho assinam o capítulo “O campo de concentração do Ipu no contexto da Revolução de 1930”. Os autores analisam a constituição do campo de concentração na cidade do Ipu no ano de 1932, no contexto de criação de outros campos, em cidades como Quixeramobim, Crato, Cariús, Senador Pompeu e Fortaleza. Os autores refletem que tal acontecimento não tem o reconhecimento e importância para os poderes locais, lamentando “que não haja um marco histórico identificando o local exato do campo de concentração do Ipu, nem um memorial preservando a memória e a história de tão trágico e lamentável acontecimento!” O campo de concentração da cidade do Ipu fazia parte de um projeto maior, que, entre outros objetivos, pretendia “fazer dele uma ‘parede de contenção’ para poupar a cidade de Sobral do assédio dos retirantes”. Nesse sentido, afirmam os autores que “Ignorar este passado horrível é o mesmo que ‘assassinar novamente’ aquelas vítimas”. Na sequência, Cid Morais Silveira, em “‘Os teus filhos, cidade encantada, escondidos no seu coração’: a vida e a morte do Centro Social Morrinhense (1952 – 1963)”, analisa a criação e o fim de uma instituição chamada Centro Social Morrinhense, em 1952, na cidade de Fortaleza, num contexto em que seus fundadores acreditavam que Morrinhos, “uma pequena vila encravada entre o litoral e o sertão, no interior cearense, composta de oito ruas, dois grandes quadriláteros que os moradores chamavam de ‘praça’ e com aproximadamente 1.097 habitantes”, estava “desamparada e abandonada pelo poder público”, objetivando “1º) proporcionar as melhores ocasiões de progresso àquela vila; 2º) levantar o nível social de seus habitantes; 3º) auxiliar os estudantes pobres do distrito; 4º) promover campanha sobre assuntos dos mais variados: educação, cultura, escolas, alfabetização de adultos, agricultura e outros problemas locais”. Joaquim dos Santos, no capítulo “‘Nas porteiras’ de outros mundos: a Pedra Branca na tradição oral”, encontrou uma pedra em seu caminho. Por isso reflete “sobre o lugar da Pedra Branca na tradição oral sobre os mortos na região do Cariri, dando destaque às memórias sobre a grande rocha e os significados que lhe são atribuídos pelos moradores das áreas próximas ao rochedo”. Aponta o autor que “a Pedra Branca está localizada no sítio Jatobá, na encosta da Chapada do Araripe, zona rural do município de Porteiras”. Ele enfatiza ainda que na “relação entre as pedras e as almas nos interiores do Brasil, é notório como seus laços são estreitos e porosos, tanto no que diz respeito às pedrinhas, quanto aos grandes rochedos”. Fechando a segunda parte e a obra, temos o capítulo de Reginaldo Alves de Araújo, “Vamos falar sobre um sertão? Do sertão dos párias incultos ao culto à pátria”, no qual o autor analisa “algumas variações de sentido da palavra sertão em diferentes momentos históricos”, atentando para o fato de que vai deixar “de lado a ideia de sertão como sinônimo de seca e de fome […] para nos concentrarmos em outras duas imagens: a de um espaço não civilizado no contexto colonial, ao sertão enquanto reservatório das raízes culturais da nacionalidade brasileira”. Entende o autor o sertão como um espaço plural e simbólico, material e sensível, sendo entendido também como um espaço de resistência renhida ao colonialismo. Voltando à trilha aberta por Carlos Drummond, no poema A suposta existência, nos diz o poeta: “[…] e tento construir-me de novo a cada instante, a cada cólica, na faina de traçar meu início […]”. O ser do poeta é parte remontada, refeita, ressignificada com a matéria da vida, com o espanto de todo dia. Ser reconstrução é sonhar ser outro a cada instante, apesar da cólica, do gemido. O que há, de fato, para se construir novo a cada instante, é uma multiplicidade de caminhos, de trilhas, de sendas abertas. O poeta nos mostra novos caminhos, assim como historiadores e historiadoras também apontam em seus trabalhos para o múltiplo das coisas, da vida, dos acontecimentos. E se uma das características da obra poética de Drummond é o “princípio-corrosão”, nas palavras de Luiz Costa Lima, nas obras dos historiadores temos, certamente, o “princípio-reflexão”, quem sabe, de forma mais ousada, o “princípio-coração”… Boa caminhada! Boa leitura! Francisco Dênis Melo

Mesenchymal stromal cells (MSCs) have the potential to treat various disease indications and are the future of cell therapy-based regenerative medicine. Typically, MSCs cryopreserved in serum-containing freezing formulation are supplied at the clinical site, which necessities that this formulation is removed before the administration. This is a cumbersome process, and there is an immediate need for identifying serum-free, xeno-free cryopreservation medium that can be readily used. Here, we analysed two commercially available serum-free, xeno-free, defined freezing media viz., CryoStor 5 (CS5) and CryoStor 10 (CS10) on their effect on human bone marrow MSCs at different freezing cell densities (5, 10, 12.5, 15 and 25 million cells per ml) over a period of 6 months and compared them to the in-house PlasmaLyte A (PLA)-based cryopreservation media. We found that the MSCs cryopreserved in CS5 and CS10 showed similar characteristics as compared with the in-house freezing media for the various parameters analysed including post-thaw recovery, viability, phenotypic marker expression, CFU-F ability and trilineage differentiation potential of the MSCs. Our results show that human MSC could be successfully cryopreserved using serum-free and xeno-free cryopreservation media and can be delivered to the bedside without any manipulations.

Renal osteodystrophy (ROD) is a term that encompasses the various consequences of chronic kidney disease (CKD) for the bone. It has been divided into several entities based on bone histomorphometry observations. ROD is accompanied by several abnormalities of mineral metabolism: abnormal levels of serum calcium, phosphorus, parathyroid hormone (PTH), vitamin D metabolites, alkaline phosphatases, fibroblast growth factor-23 (FGF-23) and klotho, which all have been identified as cardiovascular risk factors in patients with CKD. ROD can presently be schematically divided into three main types by histology: (1) osteitis fibrosa as the bony expression of secondary hyperparathyroidism (sHP), which is a high bone turnover disease developing early in CKD; (2) adynamic bone disease (ABD), the most frequent type of ROD in dialysis patients, which is at present most often observed in the absence of aluminium intoxication and develops mainly as a result of excessive PTH suppression; and (3) mixed ROD, a combination of osteitis fibrosa and osteomalacia whose prevalence has decreased in the last decade. Laboratory features include increased serum levels of PTH and bone turnover markers such as total and bone alkaline phosphatases, osteocalcin, and several products of type I collagen metabolism products. Serum phosphorus is increased only in CKD stages 4-5. Serum calcium levels are variable. They may be low initially, but hypercalcaemia develops in case of severe sHP. Serum 25-OH-vitamin D (25OHD) levels are generally below 30 ng/mL, indicating vitamin D insufficiency or deficiency. The international KDIGO guideline recommends serum PTH levels to be maintained in the range of approximately 2-9 times the upper normal normal limit of the assay and to intervene only in case of significant changes in PTH levels. It is generally recommended that calcium intake should be up to 2 g per day including intake with food and administration of calcium supplements or calcium-containing phosphate binders. Reduction of serum phosphorus towards the normal range in patients with endstage kidney failure is a major objective. Once sHP has developed, active vitamin D derivatives such as alfacalcidol or calcitriol are indicated in order to halt its progression.

Background: Hypovitaminosis D has been linked to several non-bone related diseases. Relation between serum 25-hydroxyvitamin D [25(OH)] and lung function and lung diseases has received less attention. Methods: Data from 3 National Health and Nutrition Examination Survey (NHANES) cycles, 2007-2012 were used. The sample size was 11983. Lung function markers such as forced vital capacity (FVC)and forced expiratory volume in 1 second (FEV1) were collected with Spirometry. Relation between serum 25(OH)D and lung function makers was assessed by the multivariate regression. Relation between serum 25(OH)D and prevalence of asthma, emphysema, and chronic bronchitis were assessed with multivariate-adjusted logistic regression. Results: Serum 25(OH)D was significantly associated with FVC and FEV1 (P <0.001). When data were stratified based on sex and smoking status, we found similar associations between serum 25(OH)D and lung function markers. No relation was found between serum 25(OH)D and prevalence of asthma, chronic bronchitis, and emphysema. Conclusions: Serum 25(OH)D is significantly associated with improved lung function markers. Controlled studies are needed to determine if improved serum 25(OH)D will improve the lung function in adults.

In order to protect thrombus formation, administration of low dose aspirin has become common. However, its significance for this purpose is still not clear. Effect of small dose of aspirin (ASA) onplatelet aggregation and ability of malondialdehyde(MDA) formation in platelet by the addition of arachidonic acid in vitro were investigated. In clinical study, platelet aggregation, MDA formation of platelet, serum P-thromboglobulin(p-TG), platelet factor 4(PF4) and thromboxane B2(TX-B2) levelswere measured before and after low doseaspirin therapy.Platelet aggregations by ADP, collagen, epinephrin and arachidonate as inducers were significantly suppressed under 12.5 ug/ml ASA in the medium. MDA formation of platelet was remarkably inhibited under 1.6 ug/ml of ASA in the medium in vitro.In patients, single oral dose of 50 mg ASA showed no change on platelet aggregation while the ability of MDA formation decreased 50# of the before. Serum concentration of ASA after oral dose of 50 mg ASA only showed 1.5 to 6.0 ug/ml at maximum.Daily dose of 50 mg ASA was continued during 10 days. Changes of various factors due to the time course were observed. Inhibitions of platelet aggregation were seen from 5th day on ADP and collagenand from 2nd day on epinephrin and arachidonate as inducers during the therapy. MDA formations of platelet were decreased quickly and it became almost zero at 5th day. ASA levels in the patient serum reached plateau as 8 or 9 ug/ml from 3rdday.Various patients with a possibility of thrombus formation were administered daily 50 mg ASA during 10 days. Platelet aggregations and MDA production, serum β-TG, PF4 and TXB2 levels were measured before and after the therapy. Platelet aggregations by ADP, collagen and epinephrin as inducers were significantly suppressed after the therapyand MDA production of platelet was also markedly decreased after the therapy. There were no significant changes in serumβ-TG and PF4 levels while TXB2 level tended to decrease after the therapy.From these results, it was concluded that daily 50 mg ASA oral dose was certainly effective for protection of thrombus formation.

Background: Post-menopausal women are at high risk for breast cancer. The association between serum 25-hydroxyvitamin D [25(OH)D] concentration and breast cancer in post-menopausal women is not well understood. Objectives: The aim of this study was to investigate the association between serum 25(OH)D and breast cancer using nationally representative sample surveys. Methodology: In this cross-sectional study, we used seven cycles of National Health and Nutrition Examination Surveys from 2001 through 2014. Participants were non-institutionalized post-menopausal women (n=8100). Logistic regression was performed to determine the association between serum 25(OH)D concentrations and breast cancer prevalence. A restricted cubic spline method was used to assess the non-linear association. Results: The prevalence of breast cancer was 3.3%, 4.0%, 4.6%, 6.4%, and 6.9% in the groups with serum 25(OH)D levels of <30, 30-<50, 50-<75, 75-<100, and ≥100 nmol/L, respectively. The risk of having breast cancer was significantly higher in the serum 25(OH)D 75-<100 nmol/L category compared to the 25(OH)D <30 nmol/L concentration [OR and 95% CI; 2.21 (1.23-3.98)]. Furthermore, a significant non-linear relationship between serum 25(OH)D concentrations (when used as a continuous variable) and breast cancer in all post-menopausal women (p for non-linear trend 0.032) was observed. Overall, the risk of breast cancer was highest (OR=1.5) between 70 nmol/L and 80 nmol/L of serum 25(OH)D concentration in all post-menopausal women. Conclusion: An adverse association was observed between serum 25(OH)D concentration and breast cancer in post-menopausal women. Further research is needed to elucidate the mechanism of vitamin D in cancer pathogenesis.

Review question / Objective: To systematically evaluate the efficacy and safety of cordyceps preparations as a complementary preventive therapy for Contrast-induced nephropathy (CIN). Condition being studied: At present, contrast agents are widely used in diagnostic and interventional radiology examinations worldwide. However, they can affect kidney function and cause a risk of renal impairment. Contrast-induced nephropathy (CIN) is defined as a rise in serum creatinine (SCr) levels by ≥ 25% of baseline or 44 µmol/l from the pre-contrast value within 72 h of intravascular administration of a contrast agent in the absence of an alternative etiology. The incidence of CIN varies widely among studies depending on study population and baseline risk factors, as for high-risk groups such as pre-existing renal insufficiency, diabetes, advanced age, or receiving nephrotoxic agents, the incidence is up to 30–50%. To date, CIN has been the third most common cause of hospital-acquired renal failure, after impaired renal perfusion and nephrotoxic medications, which can lead to longer hospital stay, increased costs and higher mortality.