Effect of oropharyngeal colostrum therapy in the prevention of necrotising enterocolitis among very low birthweight neonates: A meta-analysis of randomised controlled trials.

BACKGROUND: Necrotising enterocolitis (NEC) is one of the most common life-threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates. METHODS: A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi-randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta-analysis. RESULTS: In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR) = 0.64; 95% confidence interval (CI) = 0.27-1.49], mortality from any cause (typical RR = 0.86; 95% CI = 0.15-4.80) and time to reach full feed [typical weighted mean difference (WMD) = -3.26; 95% CI = -8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD = 9.77; 95% CI = 3.96-15.59). CONCLUSIONS: The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC. We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates.

Pharmacokinetics and urinary excretion of sulphadimidine in buffalo calves.

Pharmacokinetics and urinary excretion of sulphadimidine (SDI) were determined in buffalo calves following single oral administration (150 mg/kg). The plasma levels of free sulphadimidine were above minimum effective therapeutic concentration (> 40 micrograms/ml) between 4 and 12 h and the N4-acetylated form of the drug was in the range of 7.2-19.3%. Kinetic evaluation of plasma levels was performed using a two-compartment open model. The absorption and elimination half-lives of SDI were 3.01 and 11.94 h, respectively. Based on this study, an optimal dosage regimen of sulphadimidine in buffalo calves would be 100 mg/kg, followed by 50 mg/kg at 12 h intervals. Sulphadimidine was mainly excreted in the urine as free amine. The percentage of N4-acetyl sulphadimidine in urine was comparatively higher than in plasma.

Disposition of norepinephrine and epinephrine in jejunum of WLH chicken.

Disposition of (-)-norepinephrine and (-)-epinephrine in jejunum of WLH chicken was studied using oil-immersion technique. The relative rate of different routes of disposition of catecholamines was in the following order: for (-)-NE COMT greater than or equal to MAO greater than or equal to U2 greater than U1, for (-)-Epi U2 greater than or equal to COMT greater than MAO greater than U1. The role of enzymatic degradation is almost equal to that of uptake processes for (-)-Epi, but it was greater for (-)-NE.

Pharmacokinetics and urinary excretion of sulfadiazine in buffalo calves.

Pharmacokinetics and urinary excretion of sulfadiazine were determined in buffalo calves following single oral administration (150 mg/kg). Kinetic evaluation of plasma levels was performed using a 2-compartment model. The absorption half-life and elimination half-life were 3.41 +/- 0.63 and 13.75 +/- 1.94 h, respectively. Based on this study, an optimal dosage regimen of sulfadiazine in buffalo calves would be 165 mg/kg, followed by 75 mg/kg at 12-h intervals. Sulfadiazine was mainly excreted in the urine as free amine, while the percentage of acetylated sulfadiazine was comparatively low.

Disposition kinetics of gentamicin following repeated parenteral administration in buffalo calves (Bubalus bubalis).

Disposition kinetics of gentamicin was determined in buffalo calves following repeated parenteral administration of 5 mg/kg body weight. The absorption (t1/2 Ka) and elimination half-life (t1/2 beta) were found to be 0.40 +/- 0.12 and 4.33 +/- 0.39 h, respectively. Statistical comparison of the values of pharmacokinetic determinants generated in this study with the corresponding values following single intramuscular injection at the same dose level as reported earlier by GARG and GARG, 1990, revealed that the consecutive administration of drug influenced the pharmacokinetics profile of gentamicin. Elimination half-life was significantly longer (P < 0.05). Since elimination rate constant value was significantly reduced, the subsequent dosage will have to be reduced particularly if kidney functions are not normal. Otherwise, dosage regimen need not be changed.

Pharmacokinetics and urinary excretion of gentamicin in Bubalus bubalis calves following intramuscular administration.

The pharmacokinetics and urinary excretion of gentamicin was studied in buffalo calves after a single intramuscular administration (10 mg kg-1). Kinetic determinants were calculated by using a two compartment open model. The absorption (t1/2Ka) and biological half lives (t1/2 beta) were calculated to be 0.43 +/- 0.08 and 3.79 +/- 0.23 h, respectively. The value of the apparent volume of distribution (VdB) was found to be 0.38 +/- 0.07 litre kg-1. The satisfactory intramuscular dosage regimen of gentamicin for buffalo calves would be 3.23 mg kg-1 as priming dose and 2.88 mg kg-1 as maintenance dose to be repeated at 12 hour intervals to achieve and maintain the therapeutic plasma levels within safe limits. Urinary excretion of gentamicin was very rapid during the first 12 hours as 48.07 +/- 1.39 per cent of the total administered dose was excreted unchanged during this period.

Inhaled particle retention in rats receiving low exposures of diesel exhaust.

To study the effects of a low concentration exposure on the retention and clearance of submicron particles from the lungs, we exposed male Fisher 344 rats to diesel exhaust diluted to 50 micrograms diesel exhaust particles (DP)/m3, 20 h/d, 7 d/wk for 52 wk. Lung burdens (amount of DP in lungs) and the alveolar macrophage burdens were measured up to 52 wk postexposure. By 1 yr postexposure at least 80% of the DP was eliminated from the lungs and similarly cleared from the lavaged pool of macrophages. The DP remaining in the lungs was observed in alveolar, parabronchial and paravascular maculae. In contrast to previous high concentration exposure studies, only trace amounts of particles were observed in the mediastinal lymph nodes. To study the concentration dependence of particle retention, rats were exposed to equivalent exposures of 18 d x mg DP/m3 delivered at 5700 micrograms/m3 for 3 d, 1600 micrograms/m3 for 12 d, 250 micrograms/m3 for 72 d, or 50 micrograms/m3 for 365 d. Higher lung and macrophage burdens were initially achieved with the brief, high concentration exposures. During the postexposure period, animals exposed to the higher concentrations cleared more of the lung burden. Exposure to lower concentrations resulted in higher long-term lung burdens. These results are consistent with a model of lung clearance in which the macrophage burden and the duration of exposure are both important to the formation of the maculae. In a brief high concentration exposure, the macrophage burden rises rapidly, but then declines rapidly. However, in longer low concentration exposures, the macrophage burden will not reach the same peak, but stays at intermediate levels during the exposure and stimulates a steady development of the lung maculae from particle-laden macrophages leaving the active pool of pulmonary phagocytes.

Loss of androgenic induction of alpha 2u-globulin gene family in the liver of NIH black rats.

Unlike all known strains of rat, the androgen-inducible alpha 2u-globulin gene family is totally silent in the liver of NIH black (NB) rats. No endocrinological or reproductive abnormalities are apparent, and the mRNA for the androgen-repressible hepatic protein SMP-2 is normally regulated in these animals. Furthermore, immunoblot analysis shows a normal level of the male-specific cytoplasmic androgen-binding protein. Cross-breeding of the NB male and Sprague-Dawley female shows that the hybrid male in the F-1 generation regains the androgen-dependent expression of alpha 2u-globulin in the liver. These results along with the observation of high constitutive level of alpha 2u-globulin mRNA in the preputial gland of NB rats indicate a tissue- and gene-specific regulatory defect which prevents androgenic induction of alpha 2u-globulin in the liver.

Phagolysosomal alterations induced by unleaded gasoline in epithelial cells of the proximal convoluted tubules of male rats: effect of dose and treatment duration.

Short-term oral administration of unleaded gasoline to male rats reproduces the accumulation of phagolysosomes (hyaline droplets) in epithelial cells of the renal proximal convoluted tubules (PCT) observed following long-term inhalation of wholly volatilized gasoline. Phagolysosomes are partially composed of alpha 2u-globulin, a low-molecular-weight protein, unique to male rats. In this study, dose-dependent and chronologic alterations of phagolysosomes caused by gasoline were observed by transmission electron microscopy. Exposure to commercially available unleaded gasoline (0.4-2.0 ml/kg, po, once daily, 9 d) increased the number and size of phagolysosomes in epithelial cells of the PCT in male rat kidney. However, administration of 0.04 ml gasoline/kg or less was ineffective in inducing phagolysosomal accumulation. Subcellular analysis revealed that many of the phagolysosomes observed in treated rats (doses greater than 0.4 ml/kg) were angular and had cross-sectional diameters varying from 0.5 to 9 microns; in controls the majority of phagolysosomes were round and their diameter varied from 0.5 to 2.5 microns. Treatment of male rats with gasoline (2.0 ml/kg body weight, po, 1-9 d) caused a progressive increase in the number and size of phagolysosomes in PCT epithelial cells dependent on treatment duration. Alterations in phagolysosomal morphology and quantity occurred within 20 h following a single dose of gasoline, emphasizing that the process of phagolysosome accumulation is a dynamic phenomenon. Many of the enlarged phagolysosomes contained a condensed, crystalline core of greater electron density than the surrounding matrix. Furthermore, the rapid increase in abnormal, condensed contents in the phagolysosomes may indicate that a derangement of renal protein catabolism is the primary mechanism by which fuel hydrocarbons cause hyaline droplet nephropathy in male rats.

Disposition kinetics and urinary excretion of gentamicin in buffalo bulls (Bubalus bubalis).

The disposition kinetics and urinary excretion of gentamicin sulphate were studied in young buffalo bulls following a single intramuscular administration of the drug at 5 mg kg-1 body weight. The time course of the serum gentamicin concentration was adequately described by the one-compartment open model. The values of the absorption and elimination halflives were 12.2 +/- 2.2 and 167.0 +/- 29.7 min respectively. The apparent volume of distribution was 0.29 +/- 0.01 L kg-1. During the first 12 h, 63% of the total administered dose was excreted in urine. On the basis of the kinetic data, a satisfactory intramuscular dosage regimen for gentamicin sulphate would be at least 6 mg kg-1 body weight repeated at 8 h intervals.

Hydrocarbon-induced hyaline droplet nephropathy in male rats during senescence.

Male rats administered unleaded gasoline rapidly develop nephropathy characterized by accumulation of hyaline droplets in cells of the proximal convoluted tubules (PCT). This acute response is implicated in development of renal carcinoma in male rats exposed chronically to wholly volatilized gasoline. A major constituent of hyaline droplets is alpha 2 mu-globulin, a protein of hepatic origin for which the rate of synthesis declines during aging. Little information, however, is presently available on possible age-dependent susceptibility of male rats to hydrocarbon-induced nephropathy. In kidneys of untreated male Fischer 344 rats the number of constitutive hyaline droplets declined progressively with increasing age. Electrophoresis of renal cortical homogenates revealed a protein with Mr about 18 X 10(3), probably alpha 2 mu-globulin, in young (3.5 months old) male rats and total absence of this protein in aged (26 months old) males. RIA confirmed that constitutive levels of renal and hepatic alpha 2 mu-globulin in old rats were less than 1.5% of those in young adults. Unleaded gasoline (0.4 ml/kg/day, po, 5 days) caused accumulation of hyaline droplets in renal PCT of 3.5-month-old males accompanied by a marked increase (about twofold) in the renal content of alpha 2 mu-globulin, whereas the same treatment was without effect in 26-month-old rats. Finally, in the renal cortex of young rats the activities of the lysosomal proteases cathepsin B and D were increased following gasoline administration, presumably in response to protein accumulation. However, in 26-month-old rats cathepsin B activity was unaffected, while cathepsin D was increased by gasoline administration. Thus, we conclude that animal age is an important determinant in the development of hydrocarbon-induced nephropathy and only rats which produce large amounts of alpha 2 mu-globulin are susceptible to development of this pathology.

Leupeptin-mediated alteration of renal phagolysosomes: similarity to hyaline droplet nephropathy of male rats exposed to unleaded gasoline.

alpha 2u-Globulin, a protein of hepatic origin found in the urine of male rats, is accumulated in the kidney cortex during exposure to unleaded gasoline and has been implicated in the development of fuel hydrocarbon-induced nephropathy and renal neoplasia. The principal morphological feature of gasoline-induced nephropathy is accumulation of hyaline droplets (enlarged secondary lysosomes or phagolysosomes) in epithelial cells of the proximal convoluted tubule S1 and S2 segments. Inhibition of cathepsin B (a major lysosomal peptidase) by treatment of male rats with leupeptin causes rapid accumulation of phagolysosomes and alpha 2u-globulin in the kidney very similar to gasoline exposure. Further, the renal cortical subcellular distribution of alpha 2u-globulin, determined with an electron microscopic immunochemical method, is almost totally confined to phagolysosomes following administration of either gasoline or leupeptin. These results, taken together, indicate that the mechanism of nephrotoxicity of gasoline involves inhibition of renal phagolysosomal proteolysis.

Rapid postexposure decay of alpha 2u-globulin and hyaline droplets in the kidneys of gasoline-treated male rats.

Unleaded gasoline induces nephropathy, characterized by rapid accumulation of hyaline (protein resorption) droplets in epithelial cells of the renal proximal convoluted tubules, only in male rats. The hepatic synthesis of the male rat-specific protein alpha 2u-globulin, a constituent of renal hyaline droplets, is unaltered by gasoline treatment (Olson et al., 1987). Renal alpha 2u-globulin content increased to 210% of control within 18 h of a single oral dose of gasoline (2.0 ml/kg); maximal levels (320% of control) were attained following gasoline administration for 3 d. Increases in renal alpha 2u-globulin caused by gasoline were accompanied by concurrent proliferation of hyaline droplets. However, within 3 d of terminating gasoline administration renal alpha 2u-globulin content decreased to the same level as that in unexposed rats, although renal hyaline droplet number returned to pretreatment levels somewhat more slowly. The conjoint effect of postexposure recovery and estradiol (an inhibitor of hepatic alpha 2u-globulin synthesis) administration was also determined in male rats. On postexposure d 3, 6, and 9, estradiol treatment (1 mg/kg, sc, 4 d, starting on d 9 of gasoline treatment) decreased renal alpha 2u-globulin content to 75%, 59%, and 48%, respectively, of that in rats allowed to recover from gasoline with no hormone treatment. Hepatic alpha 2u-globulin content in estradiol-treated rats was decreased by 74%, 97%, and 96% at the same intervals. Estradiol treatment during recovery from gasoline also appeared to increase the removal of accumulated hyaline droplets from the renal cortex. Thus, accumulation of alpha 2u-globulin-containing hyaline droplets after subacute exposure of male rats to gasoline is rapidly reversible, dependent on continuous exposure to gasoline and maintenance of the normal rate of hepatic alpha 2u-globulin synthesis. These results emphasize the dynamic state of renal cortical hyaline droplets and suggest strongly that gasoline hydrocarbons cause hyaline droplet accumulation by prolonging the half-time of degradation of alpha 2u-globulin.

Accumulation of alpha 2u-globulin in the renal proximal tubules of male rats exposed to unleaded gasoline.

Saturated branched-chain aliphatic hydrocarbons, found in motor fuels, induce nephrotoxicity in male rats. Treatment of male rats with unleaded gasoline (0.04-2.0 ml/kg body wt, po) for 9 days increased markedly the number and size of hyaline (protein resorption) droplets in epithelial cells of the renal proximal convoluted tubules (PCT) and enhanced cellular exfoliation at high dose levels. No other treatment-related pathological effects were observed in the glomeruli, distal tubules, or medulla. The renal content of alpha 2u-globulin, a major urinary protein of male rats, was increased maximally by about 4.4-fold after gasoline administration (1.0 ml/kg, po, 9 days); no further increase was observed at higher doses. Immunoperoxidase staining of kidney tissue sections for alpha 2u-globulin revealed large accumulations of antigen localized in many of the PCT epithelial cells which contained hyaline droplets. The hepatic content of alpha 2u-globulin and its mRNA were not altered by gasoline administration. These data show, for the first time, that alpha 2u-globulin is accumulated in the kidneys of gasoline-intoxicated male rats and sequestered specifically in some of the hyaline droplets characteristic of gasoline-induced nephropathy. A hydrocarbon-induced defect in the renal lysosomal degradation of low-molecular-weight urinary proteins, rather than increased synthesis of these proteins, appears to cause hyaline droplet accumulation.