The patients were instructed to take PEG (2 L) before the CTE for bowel preparation. They were then randomized to receive 1500 mL oral contrast agent, either mannitol (isotonic mannitol solution diluted with hypertonic mannitol; Baxter, Shanghai, China) or PEG (pineapple‐flavored PEG electrolyte power dissolved to 1500‐mL volume; Wanhe Pharmaceutical, Shenzhen, Guangdong Province, China), in 50 minutes: 1000 mL within the first 30 minutes, 250 mL in the next 10 minutes and the remaining 250 mL in the last 10 minutes. After taking the contrast agent, 20 mg anisodamine hydrochloride was given intramuscularly. Patients were then transferred immediately to the CT room, and CT scan was performed within 10–20 minutes after the injection.
Mannitol
Manufactured by Baxter
Sourced in United Kingdom, China
Mannitol is a type of sugar alcohol that is commonly used in laboratory equipment and scientific research. It is a white, crystalline powder that is soluble in water and has a sweet taste. Mannitol is known for its ability to act as an osmotic agent, helping to maintain the proper balance of fluids and electrolytes in biological systems. It is often used in the formulation of various laboratory reagents and solutions.
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Lab products found in correlation
Gelofusine, by B. Braun (2 mentions)
Ringer solution, by Fresenius (1 mentions)
Ringer s solution, by Baxter (1 mentions)
Bio console 560, by Medtronic (1 mentions)
Actrapid, by Novo Nordisk (1 mentions)
Heparin, by Leo pharma (1 mentions)
Cdi 500, by Terumo (1 mentions)
Adefovir, by Merck Group (1 mentions)
Urethane, by Merck Group (1 mentions)
Solvable, by PerkinElmer (1 mentions)
Inulin, by Merck Group (1 mentions)
Ultima gold, by PerkinElmer (1 mentions)
Mannitol, by B. Braun (1 mentions)
Nutriflex, by B. Braun (1 mentions)
Bovine serum albumin (bsa), by Merck Group (1 mentions)
10 protocols using mannitol
1
Bowel Preparation for CT Enterography
2
Cardioplegia Protocol for Rat Hearts
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Crystalloid cardioplegia based on St. Thomas no. 2 cardioplegia (ST2C) [13 (link)] was prepared in the Department of Cardiac Surgery, Wroclaw Medical University (Poland). The following composition was prepared: 50 mL of Ringer solution (Fresenius Kabi, Warsaw, Poland), 5 mL of KCl (2.5 mEq/mL), 20 mL of 20% magnesium sulfate (Polpharma, Poland), and 25 mL of 20% mannitol (Baxter, Warsaw, Poland). Rat heart myocardium cells were incubated for up to 24 h in the modified cardioplegia solution.
3
Oral Contrast Administration for MRI Examinations
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60-min preparation Patients fasted for 4 h prior to the MRI examination and were instructed to ingest 1600 mL of 2% Mannitol (Baxter, Utrecht, The Netherlands) solution starting 60 min before the examination. Furthermore, patients were instructed to gradually ingest the oral contrast solution (e.g., to use the entire length of the preparation time for ingestion). The following data were retrieved: time of registration, time of start scan, sex, age, and relevant surgical and clinical history. Exact drinking times and administered volume were not documented at that time. However, an adequate estimation of drinking time could be made using the difference between the arrival time at the MRI-unit and time at start of the examination.
45-min preparation Patients fasted for 4 h prior to the MRI examination and were instructed to ingest 1600 mL of 2% Mannitol solution in three portions, starting 45 min before the scan. Furthermore, patients were instructed to gradually ingest the oral contrast solution and to ingest portion three directly before the scan. The following data were documented: relevant surgical and clinical history, drinking time, ingested volume from portion one (700 mL; 0–20 min), portion two (700 mL; 20–40 min), and portion three (200 mL; directly before scan).
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60-min preparation Patients fasted for 4 h prior to the MRI examination and were instructed to ingest 1600 mL of 2% Mannitol (Baxter, Utrecht, The Netherlands) solution starting 60 min before the examination. Furthermore, patients were instructed to gradually ingest the oral contrast solution (e.g., to use the entire length of the preparation time for ingestion). The following data were retrieved: time of registration, time of start scan, sex, age, and relevant surgical and clinical history. Exact drinking times and administered volume were not documented at that time. However, an adequate estimation of drinking time could be made using the difference between the arrival time at the MRI-unit and time at start of the examination.
45-min preparation Patients fasted for 4 h prior to the MRI examination and were instructed to ingest 1600 mL of 2% Mannitol solution in three portions, starting 45 min before the scan. Furthermore, patients were instructed to gradually ingest the oral contrast solution and to ingest portion three directly before the scan. The following data were documented: relevant surgical and clinical history, drinking time, ingested volume from portion one (700 mL; 0–20 min), portion two (700 mL; 20–40 min), and portion three (200 mL; directly before scan).
4
Perfusate Preparation for Organ Preservation
5
Ex Vivo Kidney Perfusion Protocol
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After removal from cold storage the kidneys were weighed and prepared for reperfusion on the ex vivo perfusion circuit. The renal artery, vein and ureter were cannulated and the kidney was flushed with 200 mL of cold Ringer’s solution to remove the preservation solution.
Perfusion was carried out using an adapted paediatric cardiac bypass system (Medtronic, Bioconsole 560) as described previously [4 (link), 5 (link)]. The ex vivo perfusion system was primed with 300 mL Ringer’s solution (Baxter Healthcare, Thetford UK), 2.5 g Mannitol (Baxter Healthcare), 12 mL sodium bicarbonate 8.4% (Fresenius Kabi, Runcorn, UK) and 3000 IU heparin (LEO Pharma A/S, Ballerup, Denmark). Whole blood (300 mL) was then added and recirculated to a temperature of 37.4 °C. The blood-based solution was oxygenated with a balance of 95% oxygen/5% CO2 at a flow rate of 0.1 L/min.
The blood-based solution was circulated continually through the kidney via the renal artery at a mean arterial pressure of 85 mmHg and pump speed of 1500 RPM. A nutrient solution (Synthamin 17 10%, Baxter Healthcare) with 15 mL of sodium bicarbonate 8.4% and 100 IU of insulin added (Actrapid, Novo Nordisk, London, UK) was infused at a rate of 20 mL/h. Glucose 5% (Baxter Healthcare) was infused at a rate of 5 mL/h and Ringer’s solution was used to replace urine output (mL for mL).
Perfusion was carried out using an adapted paediatric cardiac bypass system (Medtronic, Bioconsole 560) as described previously [4 (link), 5 (link)]. The ex vivo perfusion system was primed with 300 mL Ringer’s solution (Baxter Healthcare, Thetford UK), 2.5 g Mannitol (Baxter Healthcare), 12 mL sodium bicarbonate 8.4% (Fresenius Kabi, Runcorn, UK) and 3000 IU heparin (LEO Pharma A/S, Ballerup, Denmark). Whole blood (300 mL) was then added and recirculated to a temperature of 37.4 °C. The blood-based solution was oxygenated with a balance of 95% oxygen/5% CO2 at a flow rate of 0.1 L/min.
The blood-based solution was circulated continually through the kidney via the renal artery at a mean arterial pressure of 85 mmHg and pump speed of 1500 RPM. A nutrient solution (Synthamin 17 10%, Baxter Healthcare) with 15 mL of sodium bicarbonate 8.4% and 100 IU of insulin added (Actrapid, Novo Nordisk, London, UK) was infused at a rate of 20 mL/h. Glucose 5% (Baxter Healthcare) was infused at a rate of 5 mL/h and Ringer’s solution was used to replace urine output (mL for mL).
6
Cisplatin Infusion Protocol for Nephrotoxicity Reduction
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The time of initiation of cisplatin infusion was measured in hours and defined as t0h (Fig. 1 ). For both study 1 and 2, all dogs were given 0.9 % saline and Mannitol infusions to reduce the nephrotoxic effects of cisplatin (Ogilvie et al. 1988 (link)) (Fig. 1 ). A solution of 0.9 % saline (Baxter, Newbury, UK) was infused at 25 ml/kg/h−1 for 3 h (from time t-3h to t0h) via the first lumen of the JVC prior to cisplatin administration. Mannitol (0.5 mg/kg i.v.; Baxter, Newbury, UK) was infused through a 0.22-µm filter over a 15-min period from t−0.5h prior to the start of cisplatin administration. After cisplatin administration, a total volume of 0.9 % saline equal to 20 ml/kg was administered as i.v. boluses via the JVC at hourly intervals over 6 h following cisplatin treatment.![]()
Fluid and cisplatin administration protocol common to study 1 (high- vs. low-dose cisplatin) and study 2 (4-period repeated low-dose cisplatin administration)
7
Cardiopulmonary Bypass Circuit Optimization
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The CPB circuit consists of the Quadrox HMOD 71000 with an integrated Quart HBF140 arterial filter, a venous hard-shell cardiotomy reservoir, and the revolution pump for the heart–lung machine, Stöckert S5 (Sorin Group). All surfaces were coated with Safeline® coating (Maquet Cardiopulmonary) or PHYSIO® coating (Sorin Group). The priming solution consisted of Gelofusine® (B. Braun, Melsungen AG, Germany) and mannitol 200 g/l (Baxter Healthcare, Utrecht, The Netherlands). The initial heparin (Leo Pharmaceuticals, Weesp, The Netherlands) dosage was 300 IU/kg body weight, with an additional 7500 IU in the CPB circuit prime solution. Anti-coagulation through active clotting time was monitored using the Hemochron® Jr. (J.T.C. Europe, Rodano, Italy). Values >440 seconds were considered safe for CPB. The oxygenation was regulated by using in-line blood gas monitoring CDI-500® (Terumo Corporation, Tokyo, Japan) in an α-stat method, combined with a mass flow meter (Brooks Instruments, Hartfield, PA, USA). Intraoperative hemodynamic management targeted an arterial non-pulsatile flow of 2.4 L/min/m2 and mean arterial pressure >60 mmHg. The targeted value for PaO2 during the CPB time was 150 mmHg. Cardioplegia was induced by the administration of St. Thomas Hospital solution.
8
Mannitol Solution Preparation for Interferon Study
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A solution of mannitol (Osmitrol 20% mannitol Injection USP; Baxter Healthcare, Deerfield, Illinois) was prepared in the research pharmacy by mixing 20 mL Osmitrol with 80 mL sterile water (40 mg/mL mannitol, Baxter Healthcare). This mixture produced an osmolarity of 220 mOsm/L, which closely approximated the osmolarity of the interferon solution of 235 mOsm/L used by Diaz et al. 5
9
Radiolabeled Adefovir and Inulin Study
10
EVNP Circuit Priming and Monitoring
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Two identical EVNP circuits were primed with Ringer's solution supplemented with bovine serum albumin (Sigma Aldrich, Dorset, UK), 50 ml of sodium bicarbonate (8.4%), 40 ml 20% mannitol (Baxter Healthcare, Norfolk, UK), 13.2 mg dexamethasone (Hameln, Gloucester, UK), 500 mg Meropenem (Hikma, Portugal), 4000 iU unfractionated Heparin and 30 ml 15% glucose (Sigma Aldrich, Dorset, UK). A target hematocrit of 25%-30% was achieved by adding approximately 800 ml of autologous cell saved leukocyte depleted blood. A syringe driver (Williams Medical Supplies, Swansea, UK) infused GTN (1 mg/ml) at a rate of 10 ml per hour. A second syringe driver infused Nutriflex (B. Braun Medical, Sheffield, UK) supplemented with 6 ml 20% mannitol and 14 ml 15% glucose at a rate of 10 ml per hour. Gas continuously supplied to the circuit was a mixture of 95% oxygen and 5% carbon dioxide. The oxygenator was connected to the water heat exchanger pre-set to a temperature of 38°C ± 1°C. Pressure transducers were filled with Ringer's solution and equilibrated to room air.
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