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Mesoamerican nephropathy (MeN) is a progressive kidney disease found on the Pacific coast of Central America primarily in young male agricultural workers without typical kidney disease risk factors. While it is generally accepted that environmental exposures contribute to MeN, we hypothesized that there was also an important genetic component. We performed a genome-wide association study comparing individuals with MeN versus individuals with normal kidney function. We found that Native American ancestry was strongly associated with increased risk of MeN. We also identified candidate variants in the OPCML gene, which encodes a protein that binds opioid receptors, that were associated with ~sixfold reduced odds of MeN (allele frequency 0.029 in controls and 0.005 in cases, OR = 0.16; P = 4 × 10 -8 ). Sugarcane workers with the protective OPCML variants had markedly increased urine osmolality suggesting greater ability to defend against hypovolemia. Experiments with Opcml knock-out mice revealed roles for OPCML in fluid balance and temperature regulation consistent with our findings in humans. Our data suggest that heritable differential sensitivity to heat stress and dehydration contributes to high rates of kidney disease in Central America., Competing Interests: Competing interests statement:The authors declare no competing interest.

Video 1Video describing the case, procedure, and outcomes., Competing Interests: The authors did not disclose any financial relationships., (© 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

Video 1Endoscopic retrieval of a whole apple from the sigmoid colon., (© 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

Video 1., (© 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

Purpose: As the prevalence of chronic kidney disease of non-traditional origin (CKDnt) rises in low-resource settings, there is a need for reliable point-of-care creatinine testing. The purpose of this analysis was to assess the accuracy of two commonly used point-of-care creatinine devices, the i-STAT handheld (Abbott, Princeton, NJ, USA) and the StatSensor Creatinine (Nova Biomedical, Waltham, MA, USA) in comparison to venipuncture serum creatinine measures. The affordability, sensitivity, specificity, ease of use, and other considerations for each device are also presented., Methods: Three paired data sets were compared. We collected 213 paired i-STAT and venipuncture samples from a community study in Nicaragua in 2015-2016. We also collected 267 paired StatSensor Creatinine and venipuncture samples, including 158 from a community setting in Nicaragua in 2014-2015 and 109 from a Guatemala sugarcane worker cohort in 2017-2018. Pearson correlation coefficients, Bland-Altman plots, and no intercept linear regression models were used to assess agreement between point-of-care devices and blood samples., Results: The i-STAT performed the most accurately, overestimating creatinine by 0.07 mg/dL (95% CI: 0.02, 0.12) with no evidence of proportional bias. The StatSensor Creatinine performed well at low levels of creatinine (Mean (SD): 0.87 (0.19)). Due to proportional bias, the StatSensor Creatinine performed worse in the Nicaragua community setting where creatinine values ranged from 0.31 to 7.04 mg/dL., Discussion: Both devices provide acceptable sensitivity and specificity. Although adequate for routine surveillance, StatSensor Creatinine is less accurate as the values of measured creatinine increase, a consideration when using the point-of-care device for screening individuals at risk for CKDnt. Research, clinical, and screening objectives, cost, ease of use, and background prevalence of disease must all be carefully considered when selecting a point-of-care creatinine device., Conclusion: POC testing can be more accessible in resource-limited settings. The selection of the appropriate device will depend on the use-case., Competing Interests: University of Colorado and Pantaleon are separate, independent organizations. University of Colorado employed appropriate research methods in keeping with academic freedom, based conclusions on critical analysis of the evidence and reported findings fully and objectively. The terms of this arrangement have been reviewed and approved by the University of Colorado in accordance with its conflict of interest policies. Boston University and Comite Nacional de Productores de Azucar (CNPA) are separate, independent organizations. Although CNPA provided partial funding for the studies through which the data were collected, the contract was no longer in place at the time the conceptualization and analysis for this manuscript were initiated. The remaining authors declare that they have no relevant financial interests., (Copyright: © 2023 The Author(s).)

6G is already being planned and will employ much higher frequencies, leading to a revolutionary era in communication between people as well as things. It is well known that weather, especially rain, can cause increased attenuation of signal transmission for higher frequencies. The standard methods for evaluating the effect of rain on symbol error rate are based on long-term averaging. These methods are inaccurate, which results in an inefficient system design. This is critical regarding bandwidth scarcity and energy consumption and requires a more significant margin of effort to cope with the imprecision. Recently, we have developed a new and more precise method for calculating communication system performance in case of rain, using the probability density function of rain rate. For high rain rate (above 10 mm/h), for a typical set of parameters, our method shows the symbol error rate in this range to be higher by orders of magnitude than that found by ITU standard methods. Our model also indicates that sensing and measuring the rain rate probability is important in order to provide the required bit error rate to the users. This will enable the design of more efficient systems, enabling design of an adaptive system that will adjust itself to rain conditions in such a way that performance will be improved. To the best knowledge of the authors, this novel analysis is unique. It can constitute a more efficient performance metric for the new era of 6G communication and prevent disruption due to incorrect system design.