Explore the vast range of titles available.

Bronchiectasis is characterised by excessive production of mucus and pulmonary exacerbations. Inhaled osmotic agents may enhance mucociliary clearance, but few long-term clinical trials have been conducted. To determine the impact of inhaled mannitol on exacerbation rates in patients with non-cystic fibrosis (CF) bronchiectasis. Secondary endpoints included time to first exacerbation, duration of exacerbations, antibiotic use for exacerbations and quality of life (QOL) (St George's Respiratory Questionnaire, SGRQ). Patients with non-CF bronchiectasis and a history of chronic excess production of sputum and ≥2 pulmonary exacerbations in the previous 12 months were randomised (1:1) to 52 weeks treatment with inhaled mannitol 400 mg or low-dose mannitol control twice a day. Patients were 18-85 years of age, baseline FEV1 ≥40% and ≤85% predicted and a baseline SGRQ score ≥30. 461 patients (233 in the mannitol and 228 in the control arm) were treated. Baseline demographics were similar in the two arms. The exacerbation rate was not significantly reduced on mannitol (rate ratio 0.92, p=0.31). However, time to first exacerbation was increased on mannitol (HR 0.78, p=0.022). SGRQ score was improved on mannitol compared with low-dose mannitol control (-2.4 units, p=0.046). Adverse events were similar between groups. Mannitol 400 mg inhaled twice daily for 12 months in patients with clinically significant bronchiectasis did not significantly reduce exacerbation rates. There were statistically significant improvements in time to first exacerbation and QOL. Mannitol therapy was safe and well tolerated. NCT00669331.

Active glucose absorption increases passive, paracellular absorption of small solutes. Absorption of larger molecules by this mechanism has not been verified in humans under physiological conditions. The purpose of this study was to determine if ingestion of a glucose solution enhances absorption of mannitol in humans. Mannitol (182 Da) is a non‐metabolizable molecule believed to be absorbed only via the paracellular route. Its urinary excretion therefore may serve as an index for paracellular absorption of similar‐sized solutes, such as glucose (180 Da) and amino acids (average 138 Da). Eight healthy individuals (five females, three males; mean age = 22 +/− 1 yrs) ingested a 4% glucose/0.2% mannitol solution or a 4% fructose/0.2% mannitol solution using a randomized, balanced design. Urine was collected for 5 h and mannitol excretion determined. Ingestion of the glucose solution increased (p < 0.05) mannitol excretion (0.52 +/−0.27 g) compared to the fructose solution (0.39 +/−0.13 g), a 33% increase. These results indicate glucose promotes passive absorption of nutrient‐sized solutes, likely via the paracellular route. This may explain how humans can absorb high amounts of glucose when maximal active transport is exceeded. Furthermore, other nutrients such as amino acids may utilize this route, thereby enhancing absorption.

Pfs25 and Pvs25, surface proteins of mosquito stage of the malaria parasites P. falciparum and P. vivax, respectively, are leading candidates for vaccines preventing malaria transmission by mosquitoes. This single blinded, dose escalating, controlled Phase 1 study assessed the safety and immunogenicity of recombinant Pfs25 and Pvs25 formulated with Montanide ISA 51, a water-in-oil emulsion. The trial was conducted at The Johns Hopkins Center for Immunization Research, Washington DC, USA, between May 16, 2005-April 30, 2007. The trial was designed to enroll 72 healthy male and non-pregnant female volunteers into 1 group to receive adjuvant control and 6 groups to receive escalating doses of the vaccines. Due to unexpected reactogenicity, the vaccination was halted and only 36 volunteers were enrolled into 4 groups: 3 groups of 10 volunteers each were immunized with 5 microg of Pfs25/ISA 51, 5 microg of Pvs25/ISA 51, or 20 microg of Pvs25/ISA 51, respectively. A fourth group of 6 volunteers received adjuvant control (PBS/ISA 51). Frequent local reactogenicity was observed. Systemic adverse events included two cases of erythema nodosum considered to be probably related to the combination of the antigen and the adjuvant. Significant antibody responses were detected in volunteers who completed the lowest scheduled doses of Pfs25/ISA 51. Serum anti-Pfs25 levels correlated with transmission blocking activity. It is feasible to induce transmission blocking immunity in humans using the Pfs25/ISA 51 vaccine, but these vaccines are unexpectedly reactogenic for further development. This is the first report that the formulation is associated with systemic adverse events including erythema nodosum. ClinicalTrials.gov NCT00295581.

Objective Postoperative cardiac dysfunction and arrhythmias are significant complications following cardiac surgery, frequently resulting in increased mortality, longer hospital stays, higher healthcare costs, and diminished patient quality of life. This study investigates the effects of mannitol on cardiac function and the incidence of postoperative arrhythmias after coronary artery bypass grafting (CABG). Methods In a single-center, double-blind, randomized controlled trial, ninety patients undergoing elective on-pump CABG were randomly assigned (1:1) to receive either 200 mL of mannitol 20% ( n  = 45) or 200 mL of lactated Ringer’s solution ( n  = 45) during cardiopulmonary bypass priming. Postoperative assessments included cardiac enzyme levels (creatine phosphokinase, creatine kinase-MB isoenzyme, and cardiac troponin I), incidence of arrhythmias (atrial fibrillation, ventricular fibrillation, ventricular tachycardia), and left ventricular ejection fraction. Statistical significance was defined as a p-value < 0.05. Results No significant differences were observed between the mannitol and control groups in baseline demographics or clinical risk factors ( p  > 0.05). Left ventricular ejection fraction was similar between the groups (45.22 ± 9.82 in the mannitol group vs. 42.66 ± 7.94 in the control group; p  = 0.178). Atrial fibrillation occurred in 9 of 45 patients (20%) in the mannitol group and 12 of 45 (26.7%) in the control group ( p  = 0.309). Ventricular tachycardia was observed in 2 of 45 (4.4%) vs. 4 of 45 (8.9%) patients, respectively ( p  = 0.338). Thirty-day mortality was 2 of 45 (4.4%) in the mannitol group and 1 of 45 (2.2%) in the control group ( p  = 0.50). Cardiac enzyme levels (CPK, CK-MB, and cTnI) showed no significant differences between groups ( p  > 0.05). However, ventricular fibrillation occurred in 2 of 45 patients (4.4%) in the mannitol group versus 8 of 45 (17.8%) in the control group, a statistically significant difference ( p  = 0.045). Conclusions In conclusion, while mannitol was associated with a lower incidence of ventricular fibrillation, this is a single-center study with limited power to detect differences in other outcomes. Further studies with larger sample sizes are needed to confirm these findings.

Mannitol is a naturally occurring six-carbon sugar alcohol that has wide applications in the food and pharmaceutical industry because of its many properties, namely being a natural sweetener with a low metabolism and no glycemic index. The increasing demand for mannitol has spurred many studies of its production. Compared with its chemical synthesis and extraction from plants, both of which are difficult to satisfy for industrial requirements, biotechnological production of mannitol has received considerably more attention and interest from scientists because of its known advantages over those two methods. Accordingly, in this review, we summarize recent advances made in the production of mannitol through various biotechnological methods. The physicochemical properties, sources, and physiological functionalities and applications of mannitol are systematically covered and presented. Then, different determination methods for mannitol are also described and compared. Furthermore, different biotechnological strategies for the production of mannitol via fermentation engineering, protein engineering, and metabolic engineering receive a detailed overview in terms of mannitol-producing strains, enzymes, and their key reaction parameters and conditions.Key points• Physiological functionalities and applications of mannitol are presented in detail.• Different determination methods for mannitol are also described and compared.• Various biotechnological strategies for the production of mannitol are reviewed.

Mannitol, a naturally occurring polyol (sugar alcohol), is widely used in the food, pharmaceutical, medical, and chemical industries. The production of mannitol by fermentation has become attractive because of the problems associated with its production chemically. A number of homo- and heterofermentative lactic acid bacteria (LAB), yeasts, and filamentous fungi are known to produce mannitol. In particular, several heterofermentative LAB are excellent producers of mannitol from fructose. These bacteria convert fructose to mannitol with 100% yields from a mixture of glucose and fructose (1:2). Glucose is converted to lactic acid and acetic acid, and fructose is converted to mannitol. The enzyme responsible for conversion of fructose to mannitol is NADPH- or NADH-dependent mannitol dehydrogenase (MDH). Fructose can also be converted to mannitol by using MDH in the presence of the cofactor NADPH or NADH. A two enzyme system can be used for cofactor regeneration with simultaneous conversion of two substrates into two products. Mannitol at 180 gl^sup -1^ can be crystallized out from the fermentation broth by cooling crystallization. This paper reviews progress to date in the production of mannitol by fermentation and using enzyme technology, downstream processing, and applications of mannitol. [PUBLICATION ABSTRACT]

Objective To evaluate the effect of preoperative intravenous mannitol on the capsulorhexis process and intraoperative complications in patients with primary angle-closure glaucoma (PACG). Methods In this prospective randomized controlled trial, 65 PACG eyes were randomized into the mannitol and control groups. The capsulorhexis duration, number of forceps grasps, need for viscoelastic re-injection, and intraoperative complications were recorded. Results The mannitol group had a significantly shorter capsulorhexis duration and fewer forceps grasps of the capsule. All intraoperative complications (18.2%) occurred in the control group. The patients with intraoperative complications had significantly higher intraocular pressure and lower best-corrected visual acuity than those without complications after surgery. Multivariate analysis found that intravenous mannitol (odds ratio [OR] = −14.263; 95% confidence interval [CI] =−26.713 to −1.813) reduced the capsulorhexis duration, whereas zonulopathy (OR = 14.477, 95% CI = 2.622–26.331) prolonged the duration. Conclusion Preoperative intravenous mannitol can reduce the risk of intraoperative complications and improve postoperative outcomes in patients with PACG. Factors including anterior chamber depth, incision location and method, and the zonule status significantly influence the capsulorhexis process.

Objective To investigate the analgesic effects of acetaminophen–mannitol injections after endoscopic lumbar discectomy. Methods This is a prospective case–control study involving 60 patients who were randomly selected from those who underwent endoscopic lumbar discectomy for lumbar disc herniation or lumbar spinal stenosis at Sanshui District People’s Hospital of Foshan between April and September 2024. Two groups were formed by randomly assigning patients, with each group containing 30 individuals. The observation group underwent treatment with acetaminophen–mannitol for pain relief, whereas the control group was administered oral etoricoxib and intravenous mannitol. A comparison was made between the analgesic effects of the two groups. Results Compared with the control group, the observation group showed significantly lower visual analog scale scores on the first, third, and seventh days after operation (P < 0.05). The observation group had a similar time to start walking and length of hospital stay as the control group. The total incidence rate of adverse reactions was zero. Conclusion Acetaminophen–mannitol injection has a good analgesic effect after endoscopic lumbar discectomy, which is beneficial for accelerating the postoperative recovery of patients.

d-mannitol is a common six-carbon sugar alcohol, which is widely used in food, chemical, pharmaceutical, and other industries. Polymorphism is defined as the ability of materials to crystallize into different crystal structures. It has been reported for a long time that d-mannitol has three polymorphs: β, δ, and α. These different polymorphs have unique physicochemical properties, thus affecting the industrial applications of d-mannitol. In this review, we firstly introduced the characteristics of different d-mannitol polymorphs, e.g., crystal structure, morphology, molecular conformational energy, stability, solubility and the analytical techniques of d-mannitol polymorphisms. Then, we described the different strategies for the preparation of d-mannitol crystals and focused on the polymorphic control of d-mannitol crystals in the products. Furthermore, the factors of the formation of different d-mannitol polymorphisms were summarized. Finally, the application of mannitol polymorphism was summarized. The purpose of this paper is to provide new ideas for a more personalized design of d-mannitol for various applications, especially as a pharmaceutical excipient. Meanwhile, the theoretical overview on polymorphic transformation of d-mannitol may shed some light on the crystal design study of other polycrystalline materials.