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Aim: Diabetic nephropathy (DN) is the most common cause of end-stage kidney disease (ESKD). Remnant cholesterol has been investigated as a predictor for the progression of DN in type 1 diabetes mellitus patients, as well as the incidence of DN in type 2 diabetes mellitus (T2DM) patients. This study aimed to evaluate the longitudinal relationship between baseline remnant cholesterol and kidney outcomes using a Chinese T2DM with biopsy-confirmed DN cohort. Methods: We included 334 patients with T2DM and biopsy-confirmed DN during 2010–2019 West China Hospital T2DM-DN cohort. Remnant cholesterol was defined by Martin-Hopkins equation. Patients were divided into four groups based on the median (IQR) remnant cholesterol concentration at the time of renal biopsy. The kidney outcome was defined as ESKD, which was defined as the need for chronic kidney replacement therapy or estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2. The relationship between remnant cholesterol and kidney outcome was analyzed using the Kaplan‒Meier method and Cox regression analysis. Results: The mean age was 51.1 years, and 235 (70%) were men. During follow-up, a total of 121 (36.2%) patients reached ESKD. The Kaplan‒Meier analysis showed that patients in the highest quartile (quartile 4) group had lower cumulative renal survival (log-rank test, p = 0.033) and shorter median renal survival time [34.0 (26.4–41.6) vs. 55.0 (29.8–80.2) months] than patients in the lowest quartile (quartile 1) group. By univariate analysis, the high remnant cholesterol group was associated with a higher risk of progression to ESKD. Moreover, the risk of progression to ESKD in the highest quartile was still 2.857-fold (95% CI 1.305–6.257, p = 0.009) higher than that in the lowest quartile, and one-SD increase of remnant cholesterol was associated with a higher risk (HR = 1.424; 95% CI 1.075–1.886, p = 0.014) of progression to ESKD, after adjusted for confounding factors. Conclusions: High remnant cholesterol is independently associated with a higher risk of ESKD in patients with T2DM-DN, and it may be a new noninvasive marker of ESKD. Clinical relevance: Calculated remnant cholesterol has the advantages of being economical and clinically accessible. Moreover, to our knowledge, there are no longitudinal cohort studies for investigating the risk of progression of T2DM-DN to ESKD. In our study, higher remnant cholesterol was associated with a higher risk of ESKD in patients with T2DM-DN, and it may be a new noninvasive predictor of ESKD.

To investigate the relationship between serum uric acid (SUA) level and renal outcome in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN).A total of 393 Chinese patients with T2DM and biopsy-proven DN and followed at least 1 year were enrolled in this study. Patients were stratified by the quartiles of baseline level of SUA: Q1 group: 286.02 ± 46.66 μmol/L (n= 98); Q2 group: 358.23 ± 14.03 μmol/L (n= 99); Q3 group: 405.50 ± 14.59 μmol/L (n= 98) and Q4 group: 499.14 ± 56.97μmol/L (n= 98). Renal outcome was defined by progression to end-stage renal disease (ESRD). Kaplan–Meier survival analysis and Cox proportional hazards model were used to analyze the association between SUA quartiles and the renal outcomes.During the median 3-year follow-up period, there were 173 ESRD outcome events (44.02%). No significant difference between SUA level and the risk of progression of DN (P= 0.747) was shown in the Kaplan–Meier survival analysis. In multivariable-adjusted model, hazard ratios for developing ESRD were 1.364 (0.621–2.992; P= 0.439), 1.518 (0.768–3.002; P= 0.230) and 1.411 (0.706–2.821; P= 0.330) for the Q2, Q3 and Q4, respectively, in comparison with the Q1 (P= 0.652).No significant association between SUA level and renal outcome of ESRD in Chinese patients with T2DM and DN was found in our study. Besides, the role of uric acid-lowering therapy in delaying DN progression and improving ESRD outcome had not yet been proven. Further study was needed to clarify the renal benefit of the uric acid-lowering therapy in the treatment of DN.

Background

Background

With the development of DC distribution system within the isolated power system of a ship or an aircraft, more constant frequency loads will be supplied by inverters connected to DC main bus. In the operating mode conversion process of an isolated power system, inverters will inevitably suffer from serious disturbance and affect the stability of the system. Therefore, it is important to establish a model of the inverter that reflects its dynamic characteristics and based on which to conduct the stability analysis. This paper proposes a 12-pulse inverter model based on the generalized state space averaging (GSSA) method. This model can overcome the limitations of 12-pulse inverter state space averaging (SSA) model in transient analysis with good accuracy and fast analysis ability effectively. Three kinds of models for a 12-pulse aircraft inverter are built in MATLAB, namely GSSA model, SSA model and detail device model. The simulation results show the high accuracy of GSSA model in stability analysis. This study provides an effective analytical tool for stability analysis of 12-pulse inverter and also provides a reference for inverter modeling research of isolated power system such as in aircraft or ship.