Search

Background: This study aimed to explore in depth the lived experience and quality of life outcomes in patients receiving automated peritoneal dialysis (APD) treatment. Methods: The study adhered to the standards of the Consolidated Criteria for Reporting Qualitative Research. A total of 19 APD patients were recruited and assessed using in‐depth semi‐structured interviews on various aspects of life with respect to APD modality. The interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. Results: Study findings generated five superordinate themes: (a) treatment–free daily routine, (b) sleep disturbances, (c) remote care, (d) limitations of peritoneal dialysis, and (e) the dimension of chronic disease. Further analysis of the material revealed the relationship of these themes with individual patient characteristics. Conclusions: Overall, our findings suggest that APD characteristics contribute to the perceptions of quality of life in patients under dialysis considerably. [ABSTRACT FROM AUTHOR]

The article discusses the impact of the glucagon-like peptide-1 receptor agonist semaglutide on diabetic kidney disease. It highlights the positive effects of semaglutide in reducing kidney failure, cardiovascular risks, and mortality in patients with type 2 diabetes and chronic kidney disease. The FLOW trial demonstrated a 24% reduction in the primary outcome with semaglutide treatment compared to a placebo, supporting its role in providing cardiorenal protection to high-risk patients. Ongoing research is investigating the mechanisms behind semaglutide's kidney protective effects in patients with type 2 diabetes and chronic kidney disease. [Extracted from the article]

The occurrence of Potentially Toxic Elements (PTEs) and other chemical elements in urban and peri-urban soils impacts human health and quality of life, posing a challenge for geoscientists. This study investigated the soil geochemistry of Lamia City, focusing on identifying the geogenic and anthropogenic origins of elements. A total of 168 topsoil samples (0–10 cm) were collected in April 2023, and the analysis included the near-total concentrations of 51 elements. Descriptive, correlation, multivariate statistics (i.e., Factor Analysis-FA and Hierarchical Cluster Analysis-HCA), Geographic Information Systems (GIS) mapping, and mineralogical analysis were employed to identify potential element sources. The results indicated that the elements in soils originated from geogenic, anthropogenic, and mixed sources. Geogenic origins are associated with ultramafic rocks (e.g., Mg, Cr, Ni, Co, Fe, Sc, Mn), carbonate rocks (e.g., Ca, Sr), and Quaternary sediments (e.g., K, Na, Ba, Tl, Be, Rb, Ti, V, Ga, and Rare Earth Elements-REEs); associations are linked to specific identified minerals. All applied statistical analyses reveal that the mobility of chemical elements in the urban and peri-urban soils of Lamia city is primarily affected by geochemical processes such as element substitution, chemical weathering, pedogenesis, adsorption, precipitation, evaporation, and organic matter presence. The P, Ag, Hg, Pb, Sn, Zn, Sb, Cd, Cu, and U were associated with anthropogenic influences, particularly in areas with high population density, heavy vehicle traffic, and intensive agricultural practices. Additionally, some elements (e.g., Ca, Cd, Cu, Mo, Mn, and Li) exhibited mixed origins. This integrated approach offers valuable insights into the spatial distribution and sources of PTEs in urban and peri-urban environments, providing critical information for environmental management and public health protection strategies. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is the most common co-morbidity in patients with type 2 diabetes (T2D) and its presence substantially amplifies the risk for premature death, adverse cardiovascular events, and faster progression of kidney injury to kidney failure. For nearly two decades, the pharmacological blockade of the renin-angiotensin-system (RAS) was the only pillar of therapy to afford cardiorenal protection in these patients. During the last 5 years, newer novel therapies have been added to our therapeutic armamentarium, offering promise for more effective management of diabetic kidney disease in the future. Large phase 3 clinical trials have demonstrated additive cardiorenal protective benefits of sodium-glucose co-transporter type 2 (SGLT-2) inhibitors, the non-steroidal mineralocorticoid-receptor-antagonist (MRA) finerenone, and glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide relative to placebo in patients with albuminuric CKD and T2D who are receiving standard-of-care treatment with a RAS-blocker. These therapies are likely much more effective when administered in a combined therapeutic algorithm, but the potential additive effects of combination therapy remain to be established in ongoing clinical trials. In this article, we assemble four pillars of therapy for the attenuation of residual cardiorenal risk in patients with CKD associated with T2D. We provide evidence from recent randomized trials and we discuss the concept of combined treatment for maximal cardiorenal protection in this high-risk patient population. [ABSTRACT FROM AUTHOR]

Introduction: Prior observational studies conducted in the hemodialysis population have suggested a reverse association between dialysis‐unit blood pressure (BP) and mortality. The present study aimed to investigate the prognostic association of home versus dialysis‐unit BP with all‐cause mortality in hemodialysis patients. Methods: At baseline, 146 patients receiving maintenance hemodialysis underwent assessment of their BP with the following methods: (i) 2‐week averaged routine predialysis and postdialysis BP measurements; (ii) home BP monitoring for 1 week that included duplicate morning and evening BP measurements with the use of validated devices. Results: Over a median follow‐up period of 38 months (interquartile range [IQR]: 22–54), 44 patients (31.1%) died. In Kaplan–Meier curves, predialysis and postdialysis systolic BP (SBP) was not associated with all‐cause mortality, while home SBP appeared to be of prognostic significance (log rank p = 0.029). After stratifying patients into quartiles, all‐cause mortality was lowest when home SBP was ranging from 128.1 to 136.8 mmHg (quartile 2). In univariate Cox regression analysis, using quartile 2 as a referent category, the risk of all‐cause mortality was 3.32‐fold higher in quartile 1, 1.53‐fold higher in quartile 3 and 3.25‐fold higher in quartile 4. The risk‐association remained unchanged after adjustment for several confounding factors (adjusted hazard ratio: 4.79, 1.79, 3.63 for quartiles 1, 3, and 4 of home systolic BP, respectively). Conclusion: Our findings suggest that among hemodialysis patients, 1‐week averaged home SBP is independently associated with all‐cause mortality. In sharp contrast, SBP recorded either before or after dialysis over 2 weeks is not prognostically informative. [ABSTRACT FROM AUTHOR]

Ischemia‐reperfusion (I‐R) injury is the most common cause of acute kidney injury. In experiments involving primary human renal proximal tubular epithelial cells (RPTECs) exposed to anoxia‐reoxygenation, we explored the hypothesis that mitochondrial malate dehydrogenase‐2 (MDH‐2) inhibition redirects malate metabolism from the mitochondria to the cytoplasm, towards the malate‐pyruvate cycle and reversed malate‐aspartate shuttle. Colorimetry, fluorometry, and western blotting showed that MDH2 inhibition accelerates the malate‐pyruvate cycle enhancing cytoplasmic NADPH, thereby regenerating the potent antioxidant reduced glutathione. It also reversed the malate‐aspartate shuttle and potentially diminished mitochondrial reactive oxygen species (ROS) production by transferring electrons, in the form of NADH, from the mitochondria to the cytoplasm. The excessive ROS production induced by anoxia‐reoxygenation led to DNA damage and protein modification, triggering DNA damage and unfolded protein response, ultimately resulting in apoptosis and senescence. Additionally, ROS induced lipid peroxidation, which may contribute to the process of ferroptosis. Inhibiting MDH‐2 proved effective in mitigating ROS overproduction during anoxia‐reoxygenation, thereby rescuing RPTECs from death or senescence. Thus, targeting MDH‐2 holds promise as a pharmaceutical strategy against I‐R injury. [ABSTRACT FROM AUTHOR]

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. [ABSTRACT FROM AUTHOR]

This article explores the gap between knowledge and implementation in kidney care, emphasizing the need to translate evidence-based treatments into daily practice more quickly. It discusses the global issue of undiagnosed and untreated kidney disease, highlighting the importance of early diagnosis and optimal care to prevent complications. The text addresses barriers at various levels and calls for policies and improvements in healthcare systems to address these gaps. It emphasizes the importance of collaborative care models, involving various stakeholders, and the need for innovation and patient empowerment to achieve health equity. [Extracted from the article]

The present paper focuses on the investigation of the turbulent characteristics of an open-channel flow by employing the micropolar model. The underlying model has already been proven to correctly describe the secondary phase of turbulent wall-bounded flows. The open-channel case comprises an ideal candidate to further test the micropolar model as many environmental flows carry a secondary phase, the behavior of which is of great interest for applications such as sedimentation transport and debris flow. Direct Numerical Simulations (DNSs) have been carried out on an open channel for R e b = 11,200 based on mean crossectional velocity, channel height, and the fluid kinematic viscosity. The simulated results are compared against previous experimental as well as Langrangian DNS data of similar flows, with excellent agreement. The micropolar model is capable of describing the same problem but in an Eulerian frame, thus significantly simplifying the computational cost and complexity. [ABSTRACT FROM AUTHOR]

Premenopausal women generally exhibit lower blood pressure and a lower prevalence of hypertension than men of the same age, but these differences reverse postmenopause due to estrogen withdrawal. Sexual dimorphism has been described in different components of kidney physiology and pathophysiology, including the renin–angiotensin–aldosterone system, endothelin system, and tubular transporters. This review explores the sex-specific differences in kidney function and blood pressure regulation. Understanding these differences provides insights into potential therapeutic targets for managing hypertension and kidney diseases, considering the patient's sex and hormonal status. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of atrial fibrillation (AF) in patients affected by kidney failure, i.e. glomerular filtration rate <15 ml/min/1.73 m2, is high and probably underestimated. Numerous uncertainties remain regarding how to prevent thromboembolic events in this population because both cardiology and nephrology guidelines do not provide clear recommendations. The efficacy and safety of oral anticoagulant therapy (OAC) in preventing thromboembolism in patients with kidney failure and AF has not been demonstrated for either vitamin K antagonists (VKAs) or direct anticoagulants (DOACs). Moreover, it remains unclear which is more effective and safer, because estimated creatinine clearance <25–30 ml/min was an exclusion criterion in the randomized controlled trials (RCTs). Three RCTs comparing DOACs and VKAs in kidney failure failed to reach the primary endpoint, as they were underpowered. The left atrial appendage is the main source of thromboembolism in the presence of AF. Left atrial appendage closure (LAAC) has recently been proposed as an alternative to OAC. RCTs comparing the efficacy and safety of LAAC versus OAC in kidney failure were terminated prematurely due to recruitment failure. A recent prospective study showed a reduction in thromboembolic events in haemodialysis patients with AF and undergoing LAAC compared with patients taking or not taking OAC. We review current treatment standards and discuss recent developments in managing the thromboembolic risk in kidney failure patients with AF. The importance of shared decision-making with the multidisciplinary team and the patient to consider individual risks and benefits of each treatment option is underlined. [ABSTRACT FROM AUTHOR]

In the past decade, scientific research in the area of Nephrology has focused on evaluating the clinical utility and performance of various biomarkers for diagnosis, risk stratification and prognosis. Before implementing a biomarker in everyday clinical practice for screening a specific disease context, specific statistic measures are necessary to evaluate the diagnostic accuracy and performance of this biomarker. Receiver Operating Characteristic (ROC) Curve analysis is an important statistical method used to estimate the discriminatory performance of a novel diagnostic test, identify the optimal cut-off value for a test that maximizes sensitivity and specificity, and evaluate the predictive value of a certain biomarker or risk, prediction score. Herein, through practical examples, we aim to present a simple methodological approach to explain in detail the principles and applications of ROC curve analysis in the field of nephrology pertaining diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

The article discusses the global burden of kidney disease and the gaps in kidney care, particularly in low- and middle-income countries. It highlights the high death rates and economic burden associated with chronic kidney disease (CKD) and the disparities in prevention, early detection, diagnosis, and treatment. The text emphasizes the importance of integrating kidney care into national non-communicable disease strategies and strengthening health systems. It also discusses the challenges in managing CKD, including the need for regulation and monitoring of drug manufacturing, the importance of real-world data, and strategies to improve CKD management. The article addresses the cost and availability of medication for individuals with kidney disease, highlighting the paradoxical situation in high-income countries and the catastrophic health expenditure in low- and middle-income countries. It calls for pharmaceutical companies to ensure diverse participation in research studies and fair pricing of effective drugs. The article also emphasizes the need to focus on children with kidney diseases and suggests strategies to improve kidney disease care, including the use of polypills and digital technologies. It concludes with a call to action to address barriers and disparities in access to diagnosis and treatment and to ensure equitable kidney care worldwide. [Extracted from the article]

Chlorophyll a fluorescence, a sensitive and cost-effective probe, is widely used in photosynthetic research. Its rapid phase, occurring within 1 second under intense illumination, displays complex O-J-I-P transients, providing valuable insights into various aspects of photosynthesis. In addition to employing experimental approaches to measure the rapid Fluorescence Induction (FI) kinetics, mathematical modeling serves as a crucial tool for understanding the underlying mechanisms that drive FI dynamics. However, the significant uncertainty and arbitrary nature of selecting model parameters amplify concerns about the effectiveness of modeling tools in aiding photosynthesis research. Therefore, there is a need to gain a deeper understanding of how these models operate and how arbitrary parameter choices may influence their outcomes. In this study, we employed the Morris method, a global Sensitivity Analysis (SA) tool, to assess the significance of rate constants employed in an existing fluorescence model, particularly those linked to the entire electron transport chain, in shaping the rapid FI dynamics. In summary, utilizing the insights gained from the Morris SA allows for targeted refinement of the photosynthesis model, thereby improving our understanding of the complex processes inherent in photosynthetic systems. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease (CKD) suffer disproportionately from a high burden of cardiovascular disease, which, despite recent scientific advances, remains partly understood. Vascular calcification (VC) is the result of an ongoing process of misplaced calcium in the inner and medial layers of the arteries, which has emerged as a critical contributor to cardiovascular events in CKD. Beyond its established role in blood clotting and bone health, vitamin K appears crucial in regulating VC via vitamin K-dependent proteins (VKDPs). Among these, the matrix Gla protein (MGP) serves as both a potent inhibitor of VC and a valuable biomarker (in its inactive form) for reflecting circulating vitamin K levels. CKD patients, especially in advanced stages, often present with vitamin K deficiency due to dietary restrictions, medications, and impaired intestinal absorption in the uremic environment. Epidemiological studies confirm a strong association between vitamin K levels, inactive MGP, and increased CVD risk across CKD stages. Based on the promising results of pre-clinical data, an increasing number of clinical trials have investigated the potential benefits of vitamin K supplementation to prevent, delay, or even reverse VC, but the results have remained inconsistent. [ABSTRACT FROM AUTHOR]

The use of β-lactam (BL) and β-lactamase inhibitor (BLI) combinations, such as piperacillin-tazobactam (PIP-TAZ) is an effective strategy to combat infections by extended-spectrum β-lactamase-producing bacteria. However, in Gram-negative bacteria, resistance (both mutational and adaptive) to BL-BLI combination can still develop through multiple mechanisms. These mechanisms may include increased β-lactamase activity, reduced drug influx, and increased drug efflux. Understanding the relative contribution of these mechanisms during resistance development helps identify the most impactful mechanism to target in designing a treatment to counter BL-BLI resistance. This study used semi-mechanistic mathematical modeling in combination with antibiotic sensitivity assays to assess the potential impact of different resistance mechanisms during the development of PIP-TAZ resistance in a Klebsiella pneumoniae isolate expressing CTX-M-15 and SHV-1 β-lactamases. The mathematical models were used to evaluate the potential impact of several cellular changes as a sole mediator of PIP-TAZ resistance. Our semi-mechanistic model identified 2 out of the 13 inspected mechanisms as key resistance mechanisms that may independently support the observed magnitude of PIP-TAZ resistance, namely porin loss and efflux pump up-regulation. Simulation using the resulting models also suggested the possible adjustment of PIP-TAZ dose outside its commonly used 8:1 dosing ratio. The current study demonstrated how theory-based mechanistic models informed by experimental data can be used to support hypothesis generation regarding potential resistance mechanisms, which may guide subsequent experimental studies. [ABSTRACT FROM AUTHOR]

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. [ABSTRACT FROM AUTHOR]

OBJECTIVES The aim of this multicentre study was to demonstrate the safety and clinical performance of E-vita OPEN NEO Stent Graft System (Artivion, Inc.) in the treatment of aneurysm or dissection, both acute and chronic, in the ascending aorta, aortic arch and descending thoracic aorta. METHODS In this observational study of 12 centres performed in Europe and in Asia patients were enrolled between December 2020 and March 2022. All patients underwent frozen elephant trunk using E-vita OPEN NEO Stent Graft System. Primary end point was the rate of all-cause mortality at 30 days and secondary end points included further clinical and safety data are reported up to 3–6 months postoperatively. RESULTS A total of 100 patients (66.7% male; mean age, 57.7 years) were enrolled at 12 sites. A total of 99 patients underwent surgery using the E-vita OPEN NEO for acute or subacute type A aortic dissection (n  = 37), chronic type A aortic dissection (n  = 33) or thoracic aortic aneurysm (n  = 29), while 1 patient did not undergo surgery. Device technical success at 24 h was achieved in 97.0%. At discharge, new disabling stroke occurred in 4.4%, while new paraplegia and new paraparesis was reported in 2.2% and 2.2%, respectively. Renal failure requiring permanent (>90 days) dialysis or hemofiltration at discharge was observed in 3.3% of patients. Between discharge and the 3–6 months visit, no patients experienced new disabling stroke, new paraplegia or new paraparesis. The 30-day mortality was 5.1% and the estimated 6-month survival rate was 91.6% (standard deviation: 2.9). CONCLUSIONS Total arch replacement with the E-vita OPEN NEO can be performed with excellent results in both the acute and chronic setting. This indicates that E-vita OPEN NEO can be used safely, including in the setting of acute type A aortic dissection. [ABSTRACT FROM AUTHOR]

'Elderly' is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it haemodialysis, peritoneal dialysis or conservative kidney management, is complex because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or addressing selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision-making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs conservative kidney management, dialysis modality and optimal vascular access. [ABSTRACT FROM AUTHOR]

Photosynthesis under oblique illumination has not been studied extensively despite being the prevailing light regime under natural conditions. We studied how photosynthetic rate (An) is affected by the geometrical arrangement between leaf lamina and light rays, in conjunction with key anatomical features; studied plant species selected based on the absence (homobaric) or the occurrence of bundle sheath extensions (BSEs; heterobaric) and the arrangement of these structures, that is, parallel (monocots) or reticulated (dicots). The direction of light ray affected leaf absorptance (Abs) and An; both were maximal when the angle of incidence of light on leaf surface (polar angle, θ) was 90°. For any lower θ, both Abs and An were higher when the angle between the leaf axis and the light rays (azimuthal angle, φ) was zero. The dependence of Abs and An from φ was only evident in monocots and, especially, in heterobaric compared to homobaric leaves. In some species, An was substantially higher than predicted from calculated photon flux density of oblique light. The occurrence of BSEs, especially in monocots, significantly alters leaf optical properties, resulting in more efficient photosynthesis under oblique illumination conditions. Summary statement: Plant leaves harvest light for photosynthesis, usually, in a non‐perpendicular position related to the sun. Leaf anatomy increases light use efficiency under these conditions so that the rate of photosynthesis recorded is often much higher than predicted by optical geometry. [ABSTRACT FROM AUTHOR]

Background and Objectives: Secondary hyperparathyroidism (SHPT) poses a common condition among patients with chronic kidney disease (CKD) due to the chronic stimulation of the parathyroid glands as a result of persistently low calcium levels. As a first option for medical treatment, vitamin D receptor analogs (VDRAs) and calcimimetic agents are generally used. Apart from cinacalcet, which is orally taken, in recent years, another calcimimetic agent, etelcalcetide, is being administered intravenously during dialysis. Materials and Methods: In a 5-year retrospective study between 2018 and 2023, 52 patients undergoing dialysis were studied. The aim of this study is to highlight the possible effects and/or benefits that intravenously administered calcimimetic agents have on CKD patients. A total of 34 patients (65.4%) received cinacalcet and etelcalcetide while parathormone (PTH) and calcium serum levels were monitored on a monthly basis. Results: A total of 29 out of 33 patients (87.9%) that received treatment with etelcalcetide showed a significant decrease in PTH levels, which rose up to 57% compared to the initial values. None of the included patients needed to undergo parathyroidectomy (PTx) due to either extremely high and persistent PTH levels or severe side effects of the medications. It is generally strongly advised that parathyroidectomies should be performed by an expert surgical team. In recent years, a significant decrease in parathyroidectomies has been recorded globally, a fact that is mainly linked to the constantly wider use of new calcimimetic agents. This decrease in parathyroidectomies has resulted in an important decrease in complications occurring in cervical surgeries (e.g., perioperative hemorrhage and nerve damage). Conslusions: Despite the fact that these surgical complications cannot be easily compared to the pharmaceutical side effects, the recorded decrease in parathyroidectomies is considered to be notable, especially in cases of relapse where a difficult reoperation would be considered based on previously published guidelines. [ABSTRACT FROM AUTHOR]

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. [ABSTRACT FROM AUTHOR]

Introduction: Peritoneal dialysis (PD) is a life maintaining treatment in patients with end‐stage renal disease. Its chronic application leads to peritoneal mesothelial layer denudation and fibrotic transformation along with vascular activation of inflammatory pathways. The impact of different PD fluids (PDF) on mesothelial and endothelial cell function and repair mechanisms are not comprehensively described. Materials and Methods: Mesothelial (MeT‐5A) and endothelial cells (EA.hy926) were cultured in 1:1 ratio with cell medium and different PDF (icodextrin‐based, amino acid‐based, and glucose‐based). Cell adhesion, cell migration, and cell proliferation in 2D and spheroid formation and collagen gel contraction assays in 3D cell cultures were performed. Results: Cell proliferation and cell‐mediated gel contraction were both significantly decreased in all conditions. 3D spheroid formation was significantly reduced with icodextrin and amino acid PDF, but unchanged with glucose PDF. Adhesion was significantly increased by amino acid PDF in mesothelial cells and decreased by icodextrin and amino acid PDF in endothelial cells. Migration capacity was significantly decreased in mesothelial cells by all three PDF, while endothelial cells remained unaffected. Conclusions: In 3D phenotypes the effects of PDF are more uniform in both mesothelial and endothelial cells, mitigating spheroid formation and gel contraction. On the contrary, effects on 2D phenotypes are more uniform in the icodextrin and amino acid PDF as opposed to glucose ones and affect mesothelial cells more variably. 2D and 3D comparative assessments of PDF effects on the main peritoneal membrane cell barriers, the mesothelial and endothelial, could provide useful translational information for PD studies. [ABSTRACT FROM AUTHOR]

The article discusses the use of chlorthalidone, a type of diuretic, as a potential treatment for patients with resistant hypertension and stage 4 chronic kidney disease (CKD). Resistant hypertension is when blood pressure cannot be adequately controlled despite taking multiple medications. The article presents the results of a trial that showed chlorthalidone effectively lowered blood pressure and improved kidney function in these patients. The use of chlorthalidone is recommended in certain guidelines, but close monitoring is necessary to prevent adverse events. The report provides valuable and reliable information on this topic, making it a useful resource for researchers. [Extracted from the article]

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly efective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages it is ofen silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. [ABSTRACT FROM AUTHOR]

Convolutional neural networks (CNN) have been widely adopted in fluid dynamics investigations over the past few years due to their ability to extract and process fluid flow field characteristics. Both in sparse-grid simulations and sensor-based experimental data, the establishment of a dense flow field that embeds all spatial and temporal flow information is an open question, especially in the case of turbulent flows. In this paper, a deep learning (DL) method based on computational CNN layers is presented, focusing on reconstructing turbulent open channel flow fields of various resolutions. Starting from couples of images with low/high resolution, we train our DL model to efficiently reconstruct the velocity field of consecutive low-resolution data, which comes from a sparse-grid Direct Numerical Simulation (DNS), and focus on obtaining the accuracy of a respective dense-grid DNS. The reconstruction is assessed on the peak signal-to-noise ratio (PSNR), which is found to be high even in cases where the ground truth input is scaled down to 25 times. [ABSTRACT FROM AUTHOR]

Background There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). The aim of this study was to obtain a formula for stdKt/V that is able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV. Methods Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modelling using the Solute-Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b × Kru + c × eKt/V) was obtained from multivariable regression analysis of stdKt/V vs eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only seven combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week. Results The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The mean ± standard deviation stdKt/V values obtained with SS and the formula were 3.043 ± 0.530 and 2.990 ± 0.553, respectively, with 95% confidence interval +0.15 to –0.26. A 'prescription graph' was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8 ± 0.8 to 4.8 ± 0.8 weekly sessions. Conclusions The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD. [ABSTRACT FROM AUTHOR]

Data obtained using direct numerical simulations (DNS) of pressure-driven turbulent channel flow are studied in the range 180 ≤ R e τ ≤ 10,000. Reynolds number effects on the mean velocity profile (MVP) and second order statistics are analyzed with a view of finding logarithmic behavior in the overlap region or even further from the wall, well in the boundary layer's outer region. The values of the von Kármán constant for the MVPs and the Townsend–Perry constants for the streamwise and spanwise fluctuation variances are determined for the Reynolds numbers considered. A data-driven model of the MVP, proposed and validated for zero pressure-gradient flow over a flat plate, is employed for pressure-driven channel flow by appropriately adjusting Coles' strength of the wake function parameter, Π. There is excellent agreement between the analytic model predictions of MVP and the DNS-computed MVP as well as of the Reynolds shear stress profile. The skin friction coefficient Cf is calculated analytically. The agreement between the analytical model predictions and the DNS-based computed discrete values of Cf is excellent. [ABSTRACT FROM AUTHOR]

Introduction: Hospitalization for decompensated heart failure is a major public health issue. Methods: We performed a meta‐analysis to summarize and analyze if there is a benefit in using ultrafiltration over diuretics in terms of reducing mortality or hospital readmissions, primarily and identified 10 randomized controlled trials (RCTs) including 941 patients. Results: Compared to diuretics, treatment with ultrafiltration was associated with a significant reduction in heart failure hospitalizations (risk ratio [RR]: 0.72; 95% confidence interval [CI]: 0.55–0.96, p = 0.02) and significant increase in weight and net fluid loss (mean difference [MD]: −1.55, CI: −2.36 to −0.74, p = 0.0002) and (MD: −2.10, CI: −3.32 to −0.89, p = 0.0007), respectively. There was no significant difference among treatments regarding the duration of hospitalization, the increase in serum creatinine levels, and mortality. Conclusion: Among patients with decompensated heart failure, compared to diuretics, ultrafiltration is associated with reduced rehospitalizations and increased weight/net fluid loss. [ABSTRACT FROM AUTHOR]

The assumption of reference station conditions is investigated for the first time across 60 rock stations belonging to the broadband and accelerometric networks of the National Observatory of Athens. We select the stations based on the established belief that they lie on rock, and provided that their data have been publicly available for long enough to yield a substantial number of recordings. No site effects studies have been conducted before for the ensemble of the stations under study. Furthermore, no ad hoc field campaigns have been performed to characterise them, save in few cases. The first step is to compile all existing information for these stations from all publicly available sources and past studies, including geology, topography, station installation, Vs30 estimates and any other known metadata. The second step is to compile ad-hoc information from maps combined with the operator's first-hand experience of the sites, to better describe the geological unit and age, along with other characteristics such as station installation and morphology. The third and largest step is to compile the first Greek ground-motion dataset on rock and to perform a detailed analysis of the recordings to estimate site-specific transfer functions and hence assess local site response characteristics for each station. A strong-motion dataset of 6840 recordings is developed and curated for this purpose, visually inspected and processed in the time and frequency domains. Single-station amplification functions (horizontal-to-vertical spectral ratios, HVSR) are estimated from the seismic data, and the site resonance characteristics are assessed, not only in the conventional way of combining horizontal components, but also assessing the transfer function's directional sensitivity. Considering that 'true' reference site behaviour implies low, flat amplification with no directional dependence, these transfer function characteristics are combined with the compiled station metadata -existing and new- to evaluate the stations' overall capacity as reference sites. The stations are grouped interms of behaviour and the preferred ones are recommended, hoping to facilitate the better use of seismic data in future hazard applications. [ABSTRACT FROM AUTHOR]

The preliminary reference as an appeal of the Court of Justice of the European Union presents many complexities and complicated interpretations over time, given that we have a national judge in the scene of the appeal process, often creating problems but also solutions for greater effectiveness of the law of the European Union and respect for domestic law. The preliminary ruling aims to resolve disputes between internal jurisdictions and evaluate compatibility with EU law, especially in the national procedural sector. Ensuring a postponement of the EU and, above all, protecting the rights of individuals in a concrete, complete and effective way is still questionable research, not so much on a theoretical level but also on a procedural one. [ABSTRACT FROM AUTHOR]

The article discusses the use of cooler dialysate temperature as a potential intervention for preventing intradialytic hypotension in patients undergoing hemodialysis. Intradialytic hypotension is defined as a significant decline in blood pressure during dialysis that can lead to various complications. While observational studies have suggested a potential benefit of cooler dialysate temperature in reducing the risk of adverse cardiovascular events, a recent large-scale trial called MyTEMP found that individualized cooler dialysis did not improve cardiovascular outcomes or intradialytic hemodynamic stability. The article concludes that further research is needed to determine if this intervention may be beneficial for specific subgroups of dialysis patients. [Extracted from the article]

The assessment of risk and effect size of a specific endpoint associated to the presence/absence of a certain exposure is a hallmark in clinical and epidemiological research. In fact, before recommending any treatment, it is mandatory to investigate the magnitude of the benefits and harms between the exposure under investigation (e.g. a given treatment) and a specific disease or event. To do this, clinicians and statisticians use absolute (risk differences, number needed to treat, likelihood to be helped or harmed) and relative (risk ratio, incidence rate ratio, hazard ratio and odds ratio) measures of effect. Herein, using a series of clinical examples, we aim to present a step by step methodologic approach of measures of effect in the area of nephrology and urology. [ABSTRACT FROM AUTHOR]

Grapevine leaves contain abundant CaOx crystals located either within the mesophyll in the form of raphides, or in the bundle sheaths as druses. CaOx crystals function as internal carbon pools providing CO2 for a baseline level of photosynthesis, named "alarm photosynthesis", despite closed stomata; thus, preventing the photoinhibition and the oxidative risk due to carbon starvation under adverse conditions. Structural and functional leaf traits of acclimated grapevine plants (Vitis vinifera L. cv. Assyrtiko) were investigated in response to water availability, in order to evaluate the dynamic functionality of CaOx. Leaf water potential, leaf area, leaf mass per area, stomatal properties, gas exchange parameters and performance index (PI) were decreased in leaves of vines acclimated to water deficit in comparison to the leaves of well-irrigated vines, although the chlorophyll fluorescence parameters showed that the operational efficiency of the photosystem II (PSII) photochemistry (Fv/Fm) did not change, indicating that the photosynthetic apparatus was not subjected to water stress. During the afternoon, more than half of the morning's existing druses disappeared in the drought-acclimated leaves. Also, the raphides' area of the drought-acclimated leaves was reduced more than that of the well-watered leaves. The substantial decomposition of druses under water deficit conditions compared to that of the raphides may have important implications for the maintenance of their different though overlapping roles. According to the results, it seems likely that, under water deficit conditions, a mechanism of "alarm photosynthesis" provides an additional tolerance trait in the leaves of Vitis vinifera cv. Assyrtiko; hence, leaf structure relates to function. [ABSTRACT FROM AUTHOR]

The interleukin-1 gene cluster encodes cytokines, which modulate mesangial cell proliferation and matrix expansion, both constituting central factors in the development and progression of immunoglobulin A nephropathy (IgAN). A candidate-gene study was performed to examine the association of polymorphisms of the interleukin-1 gene cluster with the risk of progressive IgAN. To gain deeper insights into the involvement of interleukin genes in IgAN, a meta-analysis of genetic association studies (GAS) that examine the association between interleukin variants and IgAN was conducted. Association study: The case-control study consisted of 121 unrelated Caucasians with sporadic, histologically diagnosed IgAN and of 246 age- and sex-matched healthy controls. Persistent proteinuria (>2 g/24 h) and/or impaired kidney function (serum creatinine > 1.5 mg/dL) defined progressive (n = 67) vs. non-progressive (n = 54) IgAN cases. Genotypes were assessed for two promoter-region single-nucleotide polymorphisms, C-899T (rs1800587) in IL1A and C-511T (rs16944) in IL1B, and for one penta-allelic variable-length tandem repeat polymorphism (VNTR 86 bp intron 2) in IL1RN. The association of these variants with the susceptibility of IgAN and the development of progressive IgAN (healthy status, IgAN, progressive IgAN) was tested using the generalized odds ratio (ORG) metric. Linkage disequilibrium and haplotype analysis were also performed. Meta-analysis: We included in the meta-analysis 15 studies investigating association between 14 interleukin variants harbored in eight different genes and IgAN. The ORG was used to evaluate the association between interleukin variants and IgAN using random effects models. The present case-control study revealed association of IL1B C-511T (rs16944) with the progression of IgAN (p = 0.041; ORG = 2.11 (1.09–4.07)). On haplotype analysis, significant results were derived for the haplotypes C-C-1 (p = 0.005; OR = 0.456 (0.261~0.797)) and C-T-2 (p = 0.003; OR = 4.208 (1.545–11.50)). Regarding association and meta-analysis results, variants in IL1B (rs1143627 and rs16944), IL1RN (rs928940, rs439154, and rs315951) and IL10 (rs1800871) were associated with IgAN based on either genotype or allele counts. Genetic variants and haplotypes in the IL1B, IL1RN, and IL10 genes might contribute to an increased risk for development and progression of IgAN. [ABSTRACT FROM AUTHOR]

Vertical farming is gaining attention for urban agriculture and sustainable food production, but mainstream crops may not be economically viable in this system, prompting a shift to high-value crops. This study explores the potential of Cichorium spinosum L. (spiny chicory), a wild edible green, for vertical farming. When cultivated on open field and greenhouses, spiny chicory tends to flower prior vernalization deeming the flowered plants unsalable, necessitating an investigation on its flowering responses. C. spinosum L. plants were cultivated and for 5 months in peat-filled pots, under low light (100 μmols m2 s−1), and two photoperiods (10 and 15 h) with stable temperature (20 °C) and CO2 level (400 ppm). No flowering occurred at the end of the first experiment, indicating that photoperiod alone did not induce flowering. Next, C. spinosum L. was hydroponically cultivated under a 15 h photoperiod, light intensity of 300 μmols m−2 s−1, temperature between 25 and 30 °C, CO2 levels of 350 to 400 ppm, and plant density of 100 plants m−2. At the end of the one-month cultivation the yield of the salable fresh weight was approximately 1.7–2 kg per m2. Moreover, gas exchange measurements were conducted to analyze CO2 uptake and evapotranspiration. This study aims to enhance understanding of spiny chicory's flowering response and growth performance, providing valuable insights for cultivating this wild edible vegetable in vertical farming systems. [ABSTRACT FROM AUTHOR]

Copyright of Die Ophthalmologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ischemia–reperfusion (I–R) injury is the most common cause of acute kidney injury (AKI). Experimental studies have shown that indoleamine 2,3-dioxygenase 1 (IDO) and the purinergic receptor P2X7 contribute to kidney I–R injury. We evaluated whether there is an interplay between IDO and P2X7 in the pathogenesis of I–R injury. Primary renal proximal tubular epithelial cells (RPTECs) were subjected to anoxia or reoxygenation with or without specific inhibitors. Cell imaging, colorimetric assays, and Western blotting were used. Cell imaging revealed that inhibition of IDO, or all the purinergic receptors with an ATPase, or specific inhibition of P2X7 rescued the cells from anoxia or reoxygenation-induced cell death. This was confirmed with LDH release assay, which also detected the ferroptotic nature of cell death due to reoxygenation. On the contrary, activated cleaved caspase 3 increased during anoxia, showing that apoptosis prevails. All the aforementioned treatments prevented caspase increase. Both anoxia and reoxygenation increased extracellular ATP, IDO, and P2X7 expression. IDO remained unaffected by the above-mentioned treatments. On the contrary, treatment with apyrase or inhibition of P2X7decreased extracellular ATP and P2X7 expression, which are also decreased by inhibition of IDO. The first indicates a positive feedback loop regarding P2X7 activation, expression and function, while the latter implies that IDO controls P2X7 expression. In RPRECs subjected to anoxia or reoxygenation, IDO is upregulated, increasing P2X7 and contributing to anoxia or reoxygenation-induced cell death. Clarifying the molecular mechanisms implicated in kidney I–R injury is of particular interest since it may lead to new therapeutic strategies against AKI. [ABSTRACT FROM AUTHOR]

Data obtained by direct numerical simulations (DNS) of the Zero-Pressure-Gradient Turbulent Boundary Layer were analyzed and compared to a mathematical model of the mean velocity profile (MVP) in the range 1000 ≤ Reθ ≤ 6500. The mathematical model is based on the superposition of an accurate description of the inner law and Coles' wake function with appropriately chosen parameters. It is found that there is excellent agreement between the mathematical model and the DNS data in the inner layer when the Reynolds number based on momentum thickness, Reθ, is greater than 1000. Furthermore, there is very good agreement over the entire boundary layer thickness, when Reθ is greater than 2000. The diagnostic functions Ξ and Γ based on DNS data are examined and their characteristics are discussed in relation to the existence of a logarithmic layer or a power law behavior of the MVP. The diagnostic functions predicted by the mathematical model are also presented. [ABSTRACT FROM AUTHOR]

Background: Immune dysregulation in patients with acute COVID-19 under chronic hemodialysis (CHD) is fully not elucidated. The changes of mononuclear counts and mediators before and after HD and associations with final outcome were studied. Method: In this prospective study, hospitalized patients with moderate-to-severe COVID-19 under CHD and matched comparators under HD were analyzed for their absolute counts of lymphoid cells and circulating inflammatory mediators. Blood samples were collected before start and at the end of the first HD session; dialysate samples were also collected. Result: Fifty-nine patients with acute COVID-19 under CHD and 20 uninfected comparators under CHD were enrolled. Circulating concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-10, interferon-γ and platelet-derived growth factor-A were increased in patients. Concentrations of mediators did not differ before and after HD. Significant decreases of CD4-lymphocytes and CD19-lymphocytes were found in patients. The decrease of the expression of HLA-DR on CD14-monocytes was associated with unfavorable outcome (defined as WHO-CPS 6 or more by day 28); increased counts of CD19-lymphocytes were associated with better outcomes. Conclusion: Patients under CHD develop an inflammatory reaction to SARS-CoV-2 characterized by increase of inflammatory mediators, decrease of circulating T-lymphocytes and decrease of the expression of HLA-DR on CD14-monocytes. [ABSTRACT FROM AUTHOR]

Salinity stress is severely affecting modern horticulture and puts food security under threat for current and future generations. The aim of the present study was to evaluate the effect of saline conditions (three salinity levels: 2.0, 5.0 and 10.0 dS m−1) on the growth, physiological processes and quality of two wild edible species (Urospermum picroides and Reichardia picroides) grown under three different cropping systems (pots indoors (GP) and outdoors (FP); and floating hydroponics (FH)). Our results indicate that high salinity affected growth parameters in all the studied cropping systems in the case of U. picroides, whereas R. picroides was not affected only when grown in pots outdoors. Moreover, total soluble solids content and titratable acidity in both species were not affected by high salinity for any of the cropping systems, except for in the case of FP system. Similarly, carotenoids content decreased under high salinity when both species were grown in the FP system. A varied effect was recorded for total phenolic compounds content in response to salinity levels, although the FP system resulted in considerably higher phenolics accumulation in both species, while proline content increased when plants were subjected to high salinity, regardless of the cropping system. The antioxidant activity also varied among the studied treatments for both assays (TEAC and FRAP), although cultivation outdoors in pots resulted in considerably higher values compared to the other systems. Finally, nitrate content showed decreasing trends with increasing salinity in plants grown in the GP (both species) and FP system (only U. picroides), whereas no significant differences in physiological parameters in comparison to the control treatment were recorded, except for the stomatal conductance (FP and GP system) and transpiration rate (FP) of R. picroides plants. In conclusion, it seems that the tested plant species responded differently to the salinity treatments but they both displayed a lack of severe stress even at high salinity. [ABSTRACT FROM AUTHOR]