Search

In this study, we developed a low-cost, handheld optical biosensor for measuring blood urea nitrogen (BUN) levels in fingertip blood. This biosensor can connect to a cloud-enabled smartphone for remote monitoring of renal diseases. The biosensor features a simple, stackable and multilayer paper-based strip design, which not only achieves a linear optical fast response to BUN concentration but also reduces the complexity of the optical reader. Excellent detection performance was obtained via a unique photoelectric detection algorithm. The proportional function for calculating the analyte concentration was established using blood samples with different BUN concentrations, resulting in a wide detection range of 2.46–38.14 mM and a low detection limit of 0.03 mM. Clinical sample testing demonstrated the biosensor's high reliability, showing strong agreement with the bulky biochemistry analyzer (gold standard), with a correlation coefficient R2 = 0.9635. It is also capable of connecting to a cloud-enabled smartphone via Bluetooth to transmit test data, which has an easy-to-use interface, thus enabling proactive health management or remote diagnosis. We believe that the proposed BUN biosensor can be a big boost to the daily monitoring of renal diseases and has promising prospects in contributing to the development of the IoMT. • We developed a low-cost, handheld BUN optical biosensor for renal surveillance in fingertip blood. • The sensor achieves a linear optical fast response through a multi-layer test strip. • Reflection spectroscopy is utilized for colorimetric quantification with high sensitivity. • The biosensor has high reliability and can greatly promote the daily monitoring of kidney diseases. [ABSTRACT FROM AUTHOR]

We exploited the stability of Donor‐Acceptor polymer on the cylindrical nanopores structure to realize the sensors with a high sensitivity and stability. Then, we propose a double active layer (DL) strategy that exploits an ultra‐thin layer of Poly(3‐hexylthiophene‐2,5‐diyl) (P3HT) to serve as a work function buffer to enhance the operational current. The DL sensor exhibits a sustainable enhanced operational current of microampere level and a stable sensing response even with the presence of P3HT layer. This effect is carefully examined with different aspects, including vertical composition profile of DL configuration, lifetime testing on different sensing layer, morphological analysis, and the versatility of the DL strategy. Finally, we utilize the DL sensor to conduct a tracing of BA concentration in two HD patients before and after HD, and correlate it with the blood urea nitrogen (BUN) levels. A good correlation coefficient of 0.96 is achieved. [ABSTRACT FROM AUTHOR]

Diabetic nephropathy (DN) is an alarming consequence of diabetes mellitus, characterized by progressive kidney dysfunction and damage. Despite advancements in diabetes management, the prevalence of DN remains a significant concern. Natural compounds such as ferulic acid (FA) and protocatechuic acid (PCA) have shown potential in ameliorating diabetic complications. This research paper investigates the individual and combined effects of FA and PCA in an experimental model of DN in rats. Male rats were assigned into five groups: Control, Diabetic control, FAtreated (100 mg/kg, p.o.), PCA-treated (100 mg/kg, p.o.), and FA + PCA-treated groups. Diabetes was induced by streptozotocin injection (55 mg/kg, i.p.), and the treatment groups received oral administration of FA, PCA, or their combination for eight weeks. Renal function, oxidative stress markers, and histopathological changes were assessed at the end of the study. The diabetic control group exhibited impaired renal function, increased oxidative stress, and histological abnormalities in the kidney tissues. Treatment with FA, PCA, and FA + PCA significantly improved renal function, as evidenced by reduced serum creatinine, cystatin C, blood urea nitrogen, and urine albumin levels. Moreover, these treatments led to a decline in oxidative stress markers and restoration of antioxidant enzyme activities. The combination of FA and PCA showed a synergistic effect, demonstrating a more pronounced improvement in renal parameters and histological changes compared to individual treatments. These findings highlight the potential renoprotective effects of FA and PCA in diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Background: Laboratory parameters and the associated clinical outcomes have been an area of focus in COVID-19 research globally. Purpose: We performed a scoping review to synthesize laboratory values described in the literature and their associations with mortality and disease severity. Methods: We identified all primary studies involving laboratory values with clinical outcomes as a primary endpoint by performing data searches in various systematic review databases until 10th August, 2020. Two reviewers independently reviewed all abstracts (13,568 articles) and full text (1126 articles) data. A total of 529 studies involving 165,020 patients from 28 different countries were included. Investigation of the number of studies and patients from a geographical perspective showed that the majority of published literature from January–March 2020 to April–June 2020 was from Asia, though there was a temporal shift in published studies to Europe and the Americas. For each laboratory value, the proportion of studies that noted a statistically significant (p < 0.05) correlation with adverse clinical outcomes (e.g., mortality, disease severity) was tabulated. Results and conclusion: Among frequently reported laboratory values, blood urea nitrogen was the most often reported predictor of mortality (91%); neutrophil-to-lymphocyte ratio was the most frequent statistically significant laboratory parameter in predicting disease severity (96%). This review highlights the temporal progression of laboratory value frequencies, as well as potentially distinct utilities of different markers for clinical outcomes of COVID-19. Future research pathways include using this collected data for focused quantitative meta-analyses of particular laboratory values correlated with clinical outcomes of mortality and disease severity. [ABSTRACT FROM AUTHOR]

Background and Aims: The precise prediction of COVID‐19 prognosis remains a clinical challenge. In this regard, early identification of severe cases facilitates the triage and management of COVID‐19 cases. The present paper aims to explore the prognosis of COVID‐19 patients based on routine laboratory tests taken when patients are admitted. Methods: A data set including 1455 COVID‐19 patients (727 male, 728 female) and their routine laboratory tests conducted upon hospital admission, age, Intensive Care Unit (ICU) admission, and outcome were gathered. The data set was randomly split into the train (75% of the data) and test data set (25% of the data). The explainable boosting machine (EBM) and extreme gradient boosting (XGBoost) were used for predicting the mortality and ICU admission of COVID‐19 cases. Also, feature importance was extracted using EBM and XGBoost. Results: The EBM and XGBoost achieved 86.38% and 88.56% accuracy in the test data set, respectively. In addition, EBM and XGBoost predicted the ICU admission with an accuracy of 89.37%, and 79.29% in the test data set for COVID‐19 patients, respectively. Also, obtained models indicated that aspartate transaminase (AST), lymphocyte, blood urea nitrogen (BUN), and age are the most significant predictors of COVID‐19 mortality. Furthermore, the lymphocyte count, AST, and BUN level were the most significant ICU admission predictors of COVID‐19 patients. Conclusions: The current study indicated that both EBM and XGBoost could predict the ICU admission and mortality of COVID‐19 cases based on routine hematological and clinical chemistry evaluation at the time of admission. Also, based on the results, AST, lymphocyte count, and BUN levels could be used as early predictors of COVID‐19 prognosis. [ABSTRACT FROM AUTHOR]

To explore the association of the biochemical markers after birth with BPD-PAH, factors independently predicting BPD-PAH risk were identified by multivariate logistic regression. Cut off values were determined by plotting receiver-operator curve (ROC), for the sake of dichotomizing continuous variables that showed independent relation with BPD-PAH risk. The results show that uric acid (UC) and blood urea nitrogen (BUN) contents markedly increased among infants experiencing BPD-PAH in comparison with those without BPD-PAH (11.6 vs. 9.7 mmol/L, P = 0.006 and 482.0 vs. 249.0 μ mol/L, P < 0.001 , separately). As shown by multivariate logistic regression, serum BUN levels (OR = 1.143) and uric acid levels (OR = 1.034) were important risk factors for BPD-PAH. Through a lot of experiments, the effectiveness and the advanced nature of the framework proposed in this paper are proved effectively. The framework proposed in this paper can provide some reference and thinking for follow-up research. [ABSTRACT FROM AUTHOR]

Purpose: Excessive fluoride induces kidney injury by reducing the antioxidant capacity and causing oxidative stress. Our previous studies have shown that moderately forced treadmill running alleviates oxidative injury. However, the impact of voluntary wheel-running exercise on fluoride-intoxicated mice remains unclear. In this study, we investigated the effects of voluntary wheel-running exercise on oxidative stress-induced renal injury in fluoride-intoxicated mice. Methods: 80 Institute of Cancer Research (ICR) mice (half male and half female), were randomly divided into one of eight experimental groups: four receiving distilled water and the other four ingesting 100 mg/L sodium fluoride. Each group was subdivided to incorporate different exercise regimens--no wheelrunning, daytime, nighttime, and all-day wheel-running exercises. After 6 months, mice were euthanized for subsequent analyses. Results: HE staining revealed that 6 months of fluoride exposure caused structural damage in the kidneys of mice, elevated blood urea nitrogen (BUN), and uric acid (UA) levels in the serum. Levels of malondialdehyde (MDA), reactive oxygen species (ROS), hydrogen peroxide (H2O2), and catalase (CAT) enzyme activity significantly increased. In contrast, glutathione (GSH) content and total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) enzyme activities obviously decreased. Interestingly, these above changes were reversed by free-wheel movement. Correlation analysis demonstrated that negative relationships exist between ROS, MDA, H2O2 levels, CAT enzyme activity, and movement distance. Additionally, T-SOD and GSH-PX enzyme activities were positively associated with exercise distance. Conclusions: Voluntary wheel-running exercise mitigated renal injury induced by sodium fluoride in mice, and the extent of renal recovery was positively correlated with the distance covered during voluntary wheel-running exercise. [ABSTRACT FROM AUTHOR]

Background: Since hospitalized patients with COVID-19 are considered at high risk of death, the patients with the sever clinical condition should be identified. Despite the potential of machine learning (ML) techniques to predict the mortality of COVID-19 patients, high-dimensional data is considered a challenge, which can be addressed by metaheuristic and nature-inspired algorithms, such as genetic algorithm (GA). Objective: This paper aimed to compare the efficiency of the GA with several ML techniques to predict COVID-19 in-hospital mortality. Material and Methods: In this retrospective study, 1353 COVID-19 in-hospital patients were examined from February 9 to December 20, 2020. The GA technique was applied to select the important features, then using selected features several ML algorithms such as K-nearest-neighbor (K-NN), Decision Tree (DT), Support Vector Machines (SVM), and Artificial Neural Network (ANN) were trained to design predictive models. Finally, some evaluation metrics were used for the comparison of developed models. Results: A total of 10 features out of 56 were selected, including length of stay (LOS), age, cough, respiratory intubation, dyspnea, cardiovascular diseases, leukocytosis, blood urea nitrogen (BUN), C-reactive protein, and pleural effusion by 10-independent execution of GA. The GA-SVM had the best performance with the accuracy and specificity of 9.5147e+01 and 9.5112e+01, respectively. Conclusion: The hybrid ML models, especially the GA-SVM, can improve the treatment of COVID-19 patients, predict severe disease and mortality, and optimize the utilization of health resources based on the improvement of input features and the adaption of the structure of the models. [ABSTRACT FROM AUTHOR]

Renal fibrosis (RF) is the common pathway for a variety of chronic kidney diseases that progress to end-stage renal disease. Chitosan oligosaccharide (COS) has been identified as possessing many health functions. However, it is not clear whether COS can prevent RF. The purpose of this paper was to explore the action and mechanism of COS in alleviating RF. First, an acute unilateral ureteral obstruction operation (UUO) in male BALB/c mice was performed to induce RF, and COS or fosinopril (positive control drug) were administered for 7 consecutive days. Data from our experiments indicated that COS treatment can significantly alleviate kidney injury and decrease the levels of blood urea nitrogen (BUN) and serum creatinine (SCr) in the UUO mouse model. More importantly, our results show that COS can reduce collagen deposition and decrease the expression of fibrosis proteins, such as collagen IV, fibronectin, collagen I, α-smooth muscle actin (α-SMA) and E-cadherin, ameliorating experimental renal fibrosis in vivo. In addition, we also found that COS suppressed oxidative stress and inflammation in RF model mice. Further studies indicated that the mechanism by which COS alleviates renal fibrosis is closely related to the regulation of the TGF-β1/Smad pathway. COS has a therapeutic effect on ameliorating renal fibrosis similar to that of the positive control drug fosinopril. Taken together, COS can alleviate renal fibrosis induced by UUO by reducing oxidative stress damage and regulating the TGF-β1/Smad pathway. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases have been identified as one of the top three causes of death worldwide, with onset and deaths mostly due to heart failure (HF). In ICU, where patients with HF are at increased risk of death and consume significant medical resources, early and accurate prediction of the time of death for patients at high risk of death would enable them to receive appropriate and timely medical care. The data for this study were obtained from the MIMIC-III database, where we collected vital signs and tests for 6699 HF patient during the first 24 h of their first ICU admission. In order to predict the mortality of HF patients in ICUs more precisely, an integrated stacking model is proposed and applied in this paper. In the first stage of dataset classification, the datasets were subjected to first-level classifiers using RF, SVC, KNN, LGBM, Bagging, and Adaboost. Then, the fusion of these six classifier decisions was used to construct and optimize the stacked set of second-level classifiers. The results indicate that our model obtained an accuracy of 95.25% and AUROC of 82.55% in predicting the mortality rate of HF patients, which demonstrates the outstanding capability and efficiency of our method. In addition, the results of this study also revealed that platelets, glucose, and blood urea nitrogen were the clinical features that had the greatest impact on model prediction. The results of this analysis not only improve the understanding of patients' conditions by healthcare professionals but allow for a more optimal use of healthcare resources. [ABSTRACT FROM AUTHOR]

REGN‐EB3 (Inmazeb) is a cocktail of three human monoclonal antibodies approved for treatment of Ebola infection. This paper describes development of a mathematical model linking REGN‐EB3's inhibition of Ebola virus to survival in a non‐human primate (NHP) model, and translational scaling to predict survival in humans. Pharmacokinetic/pharmacodynamic data from single‐ and multiple‐dose REGN‐EB3 studies in infected rhesus macaques were incorporated. Using discrete indirect response models, the antiviral mechanism of action was used as a forcing function to drive the reversal of key Ebola disease hallmarks over time, for example, liver and kidney damage (elevated alanine [ALT] and aspartate aminotransferases [AST], blood urea nitrogen [BUN], and creatinine), and hemorrhage (decreased platelet count). A composite disease characteristic function was introduced to describe disease severity and integrated with the ordinary differential equations estimating the time course of clinical biomarkers. Model simulation results appropriately represented the concentration‐dependence of the magnitude and time course of Ebola infection (viral and pathophysiological), including time course of viral load, ALT and AST elevations, platelet count, creatinine, and BUN. The model estimated the observed survival rate in rhesus macaques and the dose of REGN‐EB3 required for saturation of the pharmacodynamic effects of viral inhibition, reversal of Ebola pathophysiology, and survival. The model also predicted survival in clinical trials with appropriate scaling to humans. This mathematical investigation demonstrates that drug‐disease modeling can be an important translational tool to integrate preclinical data from an NHP model recapitulating disease progression to guide future translation of preclinical data to clinical study design. [ABSTRACT FROM AUTHOR]

Continuous renal replacement therapy (CRRT) following orthotopic liver transplantation (OLT) is usually started for multifactorial reasons, with variable incidence among series. This paper presents a single-center retrospective observational study on the early use (within one week) of CRRT after consecutive cadaveric OLT from January 2008 to December 2016. Preoperative patient characteristics and intraoperative data were collected, and patients were divided into two groups (CRRT and no CRRT) to explore the factors associated with the use of CRRT. Repeated measurements of postoperative creatinine were analyzed with generalized estimating equation (GEE) models. Among 528 OLT patients, 75 (14.2%) were treated with CRRT at least once in the first week. Patients treated with CRRT showed lower survival in a Kaplan–Meier curve (log-rank p value < 0.01). Patients treated with CRRT had a more severe preoperative profile, with a significantly higher age, MELD, BUN, creatinine, and total bilirubin, as well as a longer surgery time and a higher number of transfusions of red blood cells, plasma, and platelets (all p values < 0.05). In a stepwise multiple analysis, the following characteristics remained independently associated with the use of CRRT: the MELD score OR 1.12 (95% CL: 1.07–1.16), p value < 0.001, and the preoperative value for blood urea nitrogen OR 1.016 (95% CL: 1.010–1.023), p value < 0.001. The early use of CRRT after OLT occurred at a low rate in this large cohort; however, it was associated with worse outcomes. Apart from the preoperative severity, repeated intraoperative hypotension episodes, which were likely modifiable or preventable, were associated with the increased use of CRRT and higher postoperative creatinine. [ABSTRACT FROM AUTHOR]

Objective. At present, renal injury caused by sepsis seriously endangers the health of patients. Our paper proposed to study the protective effects of meloxicam (Mel) in sepsis-induced acute kidney injury (SAKI) and the underlying mechanisms. Methods. The in vitro and in vivo models of SAKI were established using lipopolysaccharide (LPS). Mel was injected intraperitoneally at 60 mg/kg into male C57BL/6 mice 4 hours before LPS injection (10 mg/kg). The HK-2 cells were treated with LPS (1 μg/mL) and Mel (40 μM). The renal function and renal pathological changes as well as renal inflammation and apoptosis were detected in SAKI mice. The inflammation and apoptosis of HK-2 cells induced by LPS were also detected. Results. The treatment of Mel significantly decreased the elevated levels of serum creatinine (Scr) and blood urea nitrogen (BUN) in SAKI mice. In addition, the results of HE staining suggested that Mel significantly reduced kidney damage in SAKI mice. Consistently, Mel reduced the expression of LPS-induced kidney injury markers (NGAL and KIM-1). Moreover, LPS induced the expression of inflammatory cytokines (IL-1β, IL-6, and TNF-α) in the kidney, which can be reduced by Mel. Furthermore, Mel effectively reduced the number of apoptotic cells and inhibited the expression of proapoptotic-related proteins (cleaved Caspase-3 and Bax) but increased the antiapoptotic-related protein (Bcl-2) in the kidneys of SAKI mice. Mechanistically, Mel inhibited the phosphorylation of P65 but induced the phosphorylation of AKT and the expression of glycoprotein B of nonmetastatic melanoma (GPNMB). However, knocking down GPNMB can eliminate the anti-inflammatory and antiapoptotic effects of Mel. Conclusion. Mel alleviated sepsis-induced kidney injury by inhibiting kidney inflammation and apoptosis via upregulating GPNMB. [ABSTRACT FROM AUTHOR]

Background. Diabetic nephropathy (DN) is a major cause of end-stage renal disease. In order to palliate renal function impairment and reduce kidney related mortality, it is crucial to treating DN patients at the early stage. This study aims to assess the efficacy and safety of conventional therapy combined with safflower yellow versus conventional therapy alone in early DN patients. Methods. A meta-analysis of randomized controlled trials that compared safflower yellow plus conventional therapy with conventional therapy alone in early DN patients was conducted. Papers were searched using the electronic databases and reference lists. Two reviewers working independently extracted relevant data and carried out risk-of-bias assessments. Statistical analysis was undertaken in Review Manager 5.3. Results. Fourteen trials (1,072 patients) were included in the meta-analysis. Conventional therapy combined with safflower yellow was associated with a higher effective rate (RD, 0.24; 95% CI, 0.17 to 0.30) and a greater decline in urinary albumin excretion rates (SMD, -1.34; 95% CI, -1.77 to -0.92), fasting blood glucose (MD, -0.57; 95% CI, -0.98 to -0.16), serum creatinine (MD, -12.36; 95% CI, -14.66 to -10.06), and blood urea nitrogen (SMD, -0.93; 95% CI, -1.13 to -0.73) in the subgroup with a follow-up time > 15 days. The incidence of adverse events did not differ significantly between these two regimens (RD, -0.01; 95% CI, -0.03 to 0.01). Findings were similar in the subgroup with a follow-up time < 15 days. Conclusions. Conventional therapy combined with safflower yellow had a more beneficial effect than conventional therapy alone in early DN patients. There were significant differences in effective rate, urinary albumin excretion rates, fasting blood glucose, serum creatinine, and blood urea nitrogen between the two regimens and no significant difference in adverse events. More randomized controlled research using standardized protocols would be needed in the future to compare these two regimens. [ABSTRACT FROM AUTHOR]

Purpose: Herbal medicine has been used for the management of complications of diabetes. The purpose of this paper is to examine the anti-diabetic effects of Achillea millefolium extract on diabetic rats. Design/methodology/approach: To this aim, 32 male Wistar rats were randomly assigned into four groups in which each group comprised eight rats. The four experimental groups were as follows: control group, diabetic control (DC) group (STZ; 50 mg/kg), diabetic rats, receiving 250 mg/kg hydro-alcoholic extract of the A. millefolium (DAM) and diabetic rats, receiving 5 mg/kg glibenclamide (DG). After 21 days of the treatment course, tissues of the kidney and blood samples were collected for histopathological, biochemical and molecular analysis. Findings: The concentration of malondialdehyde (MDA) and glucose serum were markedly reduced in the DC group while significantly increased in DG and DAM groups (1.11 ± 0.57 to 19.4 ± 3.5 and 17.8 ± 1.2 p = 0.002 and 325 ± 0.18 to 223 ± 0.11 and 211 ± 0.32 p = 0.02, respectively). Also, the activities of glutathione peroxidase (GPx) and superoxide dismutase (SOD) were markedly reduced in the DC group while significantly increased in DAM and DG groups (9.1 ± 2.21 to 18.7 ± 3.81 and 14.9 ± 3.1 p = 0.03 and p = 0.02, respectively). The concentrations of creatinine, blood urea nitrogen (BUN) and urea were substantially decreased in DAM and DG groups as compared with the DC group (0.49 ± 0.02 to 0.27 ± 0.01 and 0.25 ± 0.01 p = 0.01, 15.6 ± 2.1 to 7.2 ± 0.68 and 8.6 ± 1.2 p = 0.02 and 114 ± 9.4 to 59.8 ± 5.2 and 64 ± 5.2 p = 0.03, respectively). Also, Bcl-2-associated X protein (BAX) expression was significantly decreased in DAM and DG groups as compared with the DC group (1.3 ± 0.32 to 0.91 ± 0.03 and 0.93 ± 0.02 p = <0.01) and Bcl-2 expression were significantly increased in DAM and DG groups as compared with the DC group (0.42 ± 0.05 to 0.88 ± 0.07 and 0.85 ± 0.06 p = 0.01). Originality/value: Diabetes led to degenerative damages in the kidney of rats and increased the mRNA level of Bax, while treatment with A. millefolium could protect the kidney tissue against diabetes complications and increased the mRNA expression of Bcl-2. This study indicated that A. millefolium extracts not only improves renal function as a result of anti-oxidant activity but also modulates some biochemical factors in diabetic rats. [ABSTRACT FROM AUTHOR]

Background and Objectives: acute kidney injury (AKI), formerly called acute renal failure (ARF), is commonly defined as an abrupt decline in renal function, clinically manifesting as a reversible acute increase in nitrogen waste products—measured by blood urea nitrogen (BUN) and serum creatinine levels—over the course of hours to weeks. AKI occurs in about 20% of all hospitalized patients and is more common in the elderly. Therefore, it is necessary to prevent the occurrence of AKI, and to detect and treat early, since it is known that a prolonged period of kidney injury increases cardiovascular complications and the risk of death. Despite advances in modern medicine, there are no consistent treatment strategies for preventing the progression to chronic kidney disease. Through many studies, the safety and efficacy of natural products have been proven, and based on this, the time and cost required for new drug development can be reduced. In addition, research results on natural products are highly anticipated in the prevention and treatment of various diseases. In relation to AKI, many papers have reported that many natural products can prevent and treat AKI. Conclusions: in this paper, the results of studies on natural products related to AKI were found and summarized, and the mechanism by which the efficacy of AKI was demonstrated was reviewed. Many natural products show that AKI can be prevented and treated, suggesting that these natural products can help to develop new drugs. In addition, we may be helpful to elucidate additional mechanisms and meta-analysis in future natural product studies. [ABSTRACT FROM AUTHOR]

In advanced Chronic Kidney Disease, patients require renal replacement therapy (dialysis or transplantation) for clearance of toxins, electrolyte and acid-base balance and removal of excess fluid. Dialysis adequacy should be taken into consideration in the adjustment of the dialysis prescription. Kt/Vurea is one method of measuring dialysis adequacy that is commonly used in clinical practice. Different formulae for calculating Kt/V are available. The appropriate Kt/V formula to be used depends on the clinical scenario, as well as parameters such as gender and size of patient, frequency of dialysis, mode of dialysis (ie hemodialysis vs, peritoneal dialysis), inter-dialysis weight gain, clinical symptoms, complications (fluid overload, hyperkalemia, intolerance to dialysis, etc), and residual kidney function. Nutrition parameters including serum protein and albumin levels, vitamin B12 and β2-microglobulin levels should be factored into the assessment of dialysis adequacy. In this review, we have described how Kt/Vurea is calculated in hemodialysis and peritoneal dialysis with examples. We reviewed the available literature by searching for papers related to calculating Kt/Vurea, single pool Kt/V, double pool Kt/V, weekly Kt/V, standard Kt/V, surface area normalized Kt/V, and various equations commonly practiced in clinical practice. We found several original articles, some review articles along with detailed information from manufacturers of different dialyzers published on their websites or as package inserts. Understanding the different equations available for calculating Kt/Vurea and the application of these results in the clinical setting is important for refining patient care and for designing clinical studies. [ABSTRACT FROM AUTHOR]

Background: Mesenchymal stem cell (MSC) therapy shows great promise for diabetic kidney disease (DKD) patients. Research has been carried out on this topic in recent years. The main goals of this paper are to evaluate the therapeutic effects of MSCs on DKD through a meta-analysis and address the mechanism through a systematic review of the literature. Method: An electronic search of the Embase, Cochrane Library, ISI Web of Science, PubMed, and US National Library of Medicine (NLM) databases was performed for all articles about MSC therapy for DKD, without species limitations, up to January 2020. Data were pooled for analysis with Stata SE 12. Result: The MSC-treated group showed a large and statistically significant hypoglycemic effect at 1 week, 2 weeks, 3 weeks, 1 month, 2 months, 3 months, and 6 months. Total hypoglycemic effect was observed (SMD = − 1.954, 95%CI − 2.389 to − 1.519, p < 0.001; I2 = 85.1%). The overall effects on serum creatinine (SCr) and blood urea nitrogen (BUN) were analyzed, suggesting that MSC decreased SCr and BUN and mitigated the impairment of renal function (SCr: SMD = − 4.838, 95%CI − 6.789 to − 2.887, p < 0.001; I2 = 90.8%; BUN: SMD = − 4.912, 95%CI − 6.402 to − 3.422, p < 0.001; I2 = 89.3%). Furthermore, MSC therapy decreased the excretion of urinary albumin. Fibrosis indicators were assessed, and the results showed that transforming growth factor-β, collagen I, fibronectin, and α-smooth muscle actin were significantly decreased in the MSC-treated group compared to the control group. Conclusion: MSCs might improve glycemic control and reduce SCr, BUN, and urinary protein. MSCs can also alleviate renal fibrosis. MSC therapy might be a potential treatment for DKD. [ABSTRACT FROM AUTHOR]

Objectives: Acute kidney injury (AKI) is a major cause of morbidity and mortality. Whether aminophylline administration can prevent or treat AKI among pediatric patients are not clear. This meta-analysis aimed to assess the efficacy and effectiveness of aminophylline for pediatric AKI. Methods: We carried out a systematic search of six databases: PubMed, EMBASE/ Excerpta Medica, Scopus, Cochrane library, and Google Scholar from January 1995 up till May 2019. Summary measures of risk ratios and standard mean difference were calculated using the random effects model. Results: We identified seven papers containing data on aminophylline use in children with AKI. Meta-analysis of single-arm studies indicated no statistically significant difference in mean rate of serum creatinine clearance (−0.39 [−0.80–1.58], P = 0.52), mean urine output (1.99 [−1.43–5.42]; P = 0.25), or mean blood urea nitrogen levels (0.83 [−1.86–3.03], P = 0.54) before and after aminophylline administration. However, among double-arm studies, aminophylline administration in the intervention arm significantly reduced the serum creatinine level as compared to control arm (mean diff = −34 [−55.18–−12.83]; P = 0.002). Mean urine output (−112.68 [−27.43–48.9], P = 0.17), incidence of AKI (RR = 1.05 [0.80–1.37], P = 0.72), and mortality rates (RR = 0.79 [0.42–1.47], P = 0.45) were found to be statistically insignificant. Conclusions: Aminophylline administration in children with AKI reduces serum creatinine level without significant adverse effects or effect on the incidence of AKI, urine output, or mortality. Further, large-scale well-planned randomized controlled trials are needed to evaluate its use and its potential long-term effects. [ABSTRACT FROM AUTHOR]

Determining reference intervals (RI) is a valuable asset for assessing the health of wildlife species. This is the first study to establish serum biochemical RIs in Siberian weasels. Forty-two healthy free-ranging Siberian weasels were captured live and brought to Seoul Wildlife Center between June 2021 and August 2022. Blood samples from 42 healthy Siberian weasels of both sexes were used to calculate RIs. An automated analyser was used to perform serum biochemistry profiles. The American Society for Veterinary Clinical Pathology recommendations were used to calculate a nonparametric RI with 90% confidence intervals. The RIs of albumin, total protein, globulin, calcium, glucose, blood urea nitrogen, phosphorus, amylase, cholesterol, alanine aminotransferase, total bilirubin, alkaline phosphatase, creatinine, and creatine kinase were determined. The RIs established in this study will serve as a good starting point for analysing serum biochemical data in Siberian weasels. [ABSTRACT FROM AUTHOR]

Background: Respiratory viruses are important etiologies of community-acquired pneumonia. However, current knowledge on the prognosis of respiratory virus-related pneumonia (RV-p) is limited. Thus, here we aimed to establish a clinical predictive model for mortality of patients with RV-p. Methods: A total of 1431 laboratory-confirmed patients with RV-p, including 1169 and 262 patients from respective derivation and validation cohorts from five teaching hospitals in China were assessed between January 2010 and December 2019. A prediction rule was established on the basis of risk factors for 30-day mortality of patients with RV-p from the derivation cohort using a multivariate logistic regression model. Results: The 30-day mortality of patients with RV-p was 16.8% (241/1431). The RV-p score was composed of nine predictors (including respective points of mortality risk): (a) age ⩾65 years (1 point); (b) chronic obstructive pulmonary disease (1 point); (c) mental confusion (1 point); (d) blood urea nitrogen (1 point); (e) cardiovascular disease (2 points); (f) smoking history (2 points); (g) arterial pressure of oxygen/fraction of inspiration oxygen (PaO2/FiO2) < 250 mmHg (2 points); (h) lymphocyte counts <0.8 × 109/L (2 points); (i) arterial PH < 7.35 (3 points). A total of six points was used as the cut-off value for mortality risk stratification. Our model showed a sensitivity of 0.831 and a specificity of 0.783. The area under the receiver operating characteristic curve was more prominent for RV-p scoring [0.867, 95% confidence interval (CI)0.846–0.886] when compared with both pneumonia severity index risk (0.595, 95% CI 0.566–0.624, p < 0.001) and CURB-65 scoring (0.739, 95% CI 0.713–0.765, p < 0.001). Conclusion: RV-p scoring was able to provide a good predictive accuracy for 30-day mortality, which accounted for a more effective stratification of patients with RV-p into relevant risk categories and, consequently, help physicians to make more rational clinical decisions. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Objective. To systematically evaluate the efficacy and safety of tanshinone for chronic kidney disease (CKD). Methods. Randomized controlled trials (RCTs) on the treatment of CKD using tanshinone were searched using 4 Chinese databases (China National Knowledge Infrastructure (CNKI), Value In Paper (VIP), Wanfang, and Chinese Biology Medicine (CBM)) and 3 English databases (PubMed, Cochrane Library, and Excerpta Medica Database (Embase)). The results included data on blood urine nitrogen (BUN), serum creatinine (Scr), glomerular filtration rate (GFR), 24 h urine protein, microalbuminuria (mALB), β2-macroglobulin (β2-MG), cystatin C (CysC), and safety events. The data were analyzed using Revman 5.3 and Stata 12.0 software. Results. Twenty-one studies were entered into this meta-analysis, which involved 1857 patients including 954 cases from the tanshinone treatment group and 903 cases from the control group. BUN levels in the tanshinone treatment group were significantly reduced compared with the control (standardized mean difference (SMD) = −0.65, 95% confidence interval (CI): −0.81 to −0.49, p < 0.01). In addition, subgroup analysis indicated that tanshinone had a significant effect in reducing Scr levels at 14, 21, and 28 days. Scr levels in the tanshinone treatment group were significantly reduced compared with the control group (SMD = −1.40, 95% CI: −2.09 to −0.71, p < 0.01); subgroup analysis based on treatment time also yielded the same results. GFR in the tanshinone treatment group was better than that in the control group (SMD = 0.83, 95% CI: 0.59 to 1.07, p < 0.01). In terms of urine protein levels, 24 h urine protein level, mALB, and β2-MG of CKD patients were reduced to some degree compared with controls, and CysC levels in the tanshinone treatment group were also significantly reduced compared with the control group (SMD = −0.24, 95% CI: −0.44 to −0.03, p < 0.05). Safety in the tanshinone treatment group did not differ significantly from that of the control group (risk ratio (RR) = 7.78, 95% CI: 0.99 to 61.05, p > 0.05). Conclusion. This meta-analysis showed that tanshinone could control urine protein level in CKD patients, improve kidney function, and delay the evolution of CKD without significant side effects. However, the results were limited and should be interpreted with caution because of the low quality of the included studies. In the future, more rigorous clinical trials need to be conducted to provide sufficient and accurate evidence. [ABSTRACT FROM AUTHOR]

Diabetic nephropathy (DN) is one of the most important comorbidities of diabetic patients, which places large physiological and economic burdens on patients. Safflower yellow, a natural pigment extracted from the petals of safflower, has been put into adjuvant therapy. Databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, MEDLINE and etc. will be searched for relevant articles. A meta-analysis was carried out to assess the efficacy and safety of safflower yellow adjuvant to conventional treatment regimen using mean differences (MD) and rate ratios (RR). A cost-effectiveness analysis was also conducted based on the result of meta-analysis. Finally, 28 articles involving 2251 patients were included in meta-analysis. The results showed that compared with conventional treatment, the fasting blood-glucose (FBG) [MD = 0.40], urinary albumin ejection rate (UAER) within 24 h [MD = 48.16], serum creatinine (Scr) [MD = 9.63], blood urea nitrogen (BUN) [MD = 1.73] were significantly lower and the clinical efficacy [RR = 1.28] was more remarkable in safflower yellow adjuvant to conventional treatment group. Our analysis suggested that safflower yellow adjuvant to conventional treatment regimen not only had better clinical efficacy but more cost-effective than conventional treatment regimen. [ABSTRACT FROM AUTHOR]

Simplified rapid hydration has been proven to be non-inferior to standard hydration in preventing contrast-associated acute kidney injury among chronic kidney disease patients undergoing coronary angiography. The current investigation aimed to further confirm the feasibility and safety of the newly proposed hydration method-simplified rapid hydration (SH) in each risk stratification by Mehran risk score (MRS). Eligible patients (n = 954) randomized to the SH group and standard hydration group were allocated into 2 groups based on MRS: low to moderate-risk and high to very high-risk groups. Primary endpoints were the incidence of contrast-associated acute kidney injury (CA-AKI) and acute heart failure (AHF) (SH vs standard hydration). Secondary endpoints included serum creatinine (Scr), blood urea nitrogen (BUN), cystatin-C (Cys-C), and C-reactive protein (CRP) at 24 h, 48 h, and 72 h after PCI procedure, and the incidence of major adverse cardiac events (MACE). MRS was associated with a higher incidence of CA-AKI (OR = 1.101, 95%CI 1.049–1.156, P < 0.001). In the low to moderate-risk and high to very-high-risk groups, the incidence of CA-AKI in the SH and standard hydration group was 3.3% versus 4.9% (P = 0.5342), 10% versus 12% (P = 0.6392), respectively. Meanwhile, there might be subtle differences in renal function indexes and inflammatory indicators between SH and the control group at different time points. The preventive effect of SH in CA-AKI was similar to standard hydration regardless of MRS-guided risk stratification. [ABSTRACT FROM AUTHOR]

Background: Observational studies have suggested an association between obstructive sleep apnea (OSA), chronic kidney disease (CKD), and renal function, and vice versa. However, the results from these studies are inconsistent. It remains unclear whether there are causal relationships and in which direction they might exist. Methods: We used a two-sample Mendelian randomization (MR) method to investigate the bidirectional causal relation between OSA and 7 renal function phenotypes [creatinine-based estimated glomerular filtration rate (eGFRcrea), cystatin C-based estimated glomerular filtration rate (eGFRcys), blood urea nitrogen (BUN), rapid progress to CKD, rapid decline of eGFR, urinary albumin to creatinine ratio (UACR) and CKD]. The genome-wide association study (GWAS) summary statistics of OSA were retrieved from FinnGen Consortium. The CKDGen consortium and UK Biobank provided GWAS summary data for renal function phenotypes. Participants in the GWAS were predominantly of European ancestry. Five MR methods, including inverse variance weighted (IVW), MR-Egger, simple mode, weighted median, and weighted mode were used to investigate the causal relationship. The IVW result was considered the primary outcome. Then, Cochran's Q test and MR-Egger were used to detect heterogeneity and pleiotropy. The leave-one-out analysis was used for testing the stability of MR results. RadialMR was used to identify outliers. Bonferroni correction was applied to test the strength of the causal relationships (p < 3.571 × 10-3). Results: We failed to find any significant causal effect of OSA on renal function phenotypes. Conversely, when we examined the effects of renal function phenotypes on OSA, after removing outliers, we found a significant association between BUN and OSA using IVW method (OR: 2.079, 95% CI: 1.516-2.853; p = 5.72 × 10-6). Conclusion: This MR study found no causal effect of OSA on renal function in Europeans. However, genetically predicted increased BUN is associated with OSA development. These findings indicate that the relationship between OSA and renal function remains elusive and requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: Accumulating experimental evidence has shown that resveratrol supplementation is effective for treating diabetic nephropathy (DN) in animal models. In this systematic review and meta‐analysis, we assessed the effects and multiple mechanisms of resveratrol in animal models of DN. Methods: Before September 2023, preclinical literature was systematically searched and screened across PubMed, Web of Science, EMBASE, and the Cochrane Library. Forty‐two studies were included, and the risk of bias tool from SYRCLE was used to assess the methodological quality. Pooled overall effect sizes of the results were generated by STATA 16.0. Results: The overall results provide preliminary evidence that the consumption of resveratrol can significantly reduce the mesangial index, glomerular basement membrane thickness, glomerular hypertrophy, serum creatinine, blood urea nitrogen, 24‐h urinary protein, blood glucose, kidney index, total cholesterol, triglyceride, and low‐density lipoprotein cholesterol levels. In contrast, the levels of albumin and high‐density lipoprotein cholesterol are significantly increased. However, resveratrol did not significantly reduce creatinine clearance or glycated hemoglobin levels. Dose–response analysis revealed that resveratrol was most effective at improving kidney function and reducing DN when administered at lower doses of ≤15 mg/kg/day or higher doses of 100–200 mg/kg/day, with significant improvements in biochemical kidney injury markers and a better effect on dysglycemia. Conclusions: The benefits of resveratrol in DN are likely due to its anti‐inflammatory, antioxidant, metabolic regulatory, and autophagy‐promoting effects. To confirm these findings for clinical use, further large‐scale, long‐term, high‐quality preclinical trials are warranted to accurately assess the anti‐DN effects and safety of resveratrol. [ABSTRACT FROM AUTHOR]

Fortified human milk is the first choice for preterm infants. Although individualized fortification is recommended, the optimal method for this population remains uncertain. We conducted a comparative study assessing the growth effects of adjusted (AF) and targeted fortification (TF) in extremely low birth weight (ELBW) infants. This single-center, randomized, controlled clinical trial was conducted at a tertiary neonatal unit in Spain. Eligible participants were premature infants with a birthweight of <1000 g exclusively fed with human milk. A total of 38 patients were enrolled, 15 of them randomized to AF group and 23 to TF group. AF was based on blood urea nitrogen (BUN) concentration and TF on human milk analysis. The primary outcome was weight gain velocity (g/kg/day). No significant differences were found in weight gain velocity at 28 days, at 36 weeks of postmenstrual age, at discharge, nor during the intervention. Protein intake was significantly higher in the AF group (5.02 g/kg/day vs. 4.48 g/kg/day, p = 0.001). No differences were found in the lipid, carbohydrate, and energy intake; in the weight z score change between the different time points; nor in the length and head circumference growth. Both AF and TF are comparable methods of fortification and provide the appropriate growth rate in ELBW infants. [ABSTRACT FROM AUTHOR]

Endometritis is an important factor in cattle fertility. Pathogenicity and the development of numerous reproductive diseases are directly related to bacterial imbalance in the genital tract. A commercial antibiotic can be relatively costly and can disrupt the animal's usual gut microflora; instead of plant medicals. The aim of this study was to develop an effective artificial insemination (AI) gel from traditional Thai herbs that exhibit bacterial inhibition. Twenty-four female Thai native cattle were divided into two groups: endometritis and healthy. Uterine swabs were isolated, identified, and tested for bacterial biofilm formation in vitro. Brucella ovis, Campylobacter fetus, Helicobacter trogontum, and Arcobacter cryaerophilus were found in female genitalia with endometritis based on weak biofilm information. Garcinia mangostana Linn. and Achyranthes aspera Linn. extracts were tested for antibacterial activity using agar dilution assay. A 10 μg/mL concentration of both extracts in combination was effective against the mixed bacterial isolation. The specific AI gel with those extracts was then developed (so-called GA-Gel) in vivo. The combined extracts inhibited the endometritis bacteria that expressed antimicrobial activity in vivo. Their hematological profiles indicated that the total white blood cells, neutrophils, and lymphocytes counts decreased (p=0.05). Compared to healthy cattle, the treated cattle had no significant difference in the levels of aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and creatinine. Both in vivo and in vitro indicated that the GA-Gel was effective for the prevention of an increase of bacteria and can be potentially developed to be an efficient AI gel. [ABSTRACT FROM AUTHOR]

Objective: In this study, the protective effects of native Iranian probiotics (Lactobacillus rhamnosus, Lactobacillus casei and Lactobacillus holoticus) on lead acetate (PbAc)-induced toxicity in the kidney of male rats were investigated using biochemical, molecular and histopathological approaches. Materials and Methods: Twenty-one male Wistar rats were divided into three groups (n=7/group), including controls, PbAc recipient (10 mg/kg) and PbAc recipient (10 mg/kg) + probiotic mixture (109 CFU). PbAc and probiotics were gavage in the groups. On the 31st day, blood samples were used to measure serum concentrations of creatinine (Cr), blood urea nitrogen (BUN), sodium, total protein and potassium. Rats were dissected and renal tissues apoptotic and inflammatory genes were evaluated. Results: PbAc increased serum concentrations of Cr, sodium, and urea, and decreased total protein and potassium, while it enhanced interleukine-6 (IL-6) and tumor necrosis factor -α (TNF- α) gene expression in kidney tissue compared to the control group. Probiotic mixture decreased Cr, BUN, and malondialdehyde and increased activity of catalase and superoxide dismutase enzymes in kidney tissue. Conclusion: The results of the study showed that the native Iranian probiotics mixture can be used to protect the function and structure of the kidneys against toxic and oxidative damage induced by PbAc. [ABSTRACT FROM AUTHOR]

This research aims to investigate the acute toxicity profile of the ethanolic extract derived from Cyanometra cauliflora fruit, a plant commonly found in Southeast Asia. Male ICR mice were divided into 5 groups and administered varying oral doses of C. cauliflora extract: 100, 200 and 400 mg/kg body weight. Subsequently, the effects on both histological and biochemical parameters were meticulously examined post-experimentation. The results indicated no significant alterations in blood glucose or blood urea nitrogen (BUN) levels attributable to C. cauliflora extract administration. Nevertheless, a noteworthy elevation in creatinine, aspartate transaminase (AST), and alkaline phosphatase (ALP) levels was observed across all groups treated with C. cauliflora extract in comparison to controls (p < 0.05). Intriguingly, the extract consistently elicited a reduction in triglyceride levels across all administered doses, while cholesterol levels exhibited a decline specifically at the 400 mg/kg body weight dose. Notably, the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) remained unaltered throughout the experimentation. Histological assay suggested signs of hepatocellular damage, portal dilation and infiltration of inflammatory cells across all C. cauliflora-treated groups, alongside indications of kidney atrophy and other abnormalities. These findings collectively suggest structural and functional modifications induced by C. cauliflora extract. In summary, while the administration of C. cauliflora extract did not exert significant changes in blood glucose and BUN levels, it did lead to heightened levels of creatinine and liver enzyme markers. Furthermore, liver and kidney damage were discerned at doses ranging from 100 to 400 mg/kg body weight, underscoring the imperative need to optimize extract concentrations to mitigate potential cytotoxic effects. These findings can be further explored to understand the processes behind the observed effects and to assess potential therapeutic applications or safety considerations associated with the use of C. cauliflora extract in clinical settings. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate pathological epidemiology and molecular confirmation of Ehrlichia canis among pet dogs in Bhubaneswar, Odisha, a state in eastern India. A total of 178 dogs were screened for Ehrlichiosis based on history, clinical signs, blood, and buffy coat smear examination, resulting in only 56 dogs (31.46%) screening positive. The epidemiological study recorded a non-significant (p ≥ 0.05) increase in incidences among male dogs (68%), German Shepherds (25%), dogs more than 20 kg body weight (75%), in the summer months (55%), and dogs housed in pukka houses with exposure to the outside (59%). The majority of the infected dogs had a history of tick infestation (79%) at some point in their lives. Clinical signs showed non-typical manifestations like fever, lethargy, diarrhoea, epistaxis, hind limb edema, and corneal opacity. Haematological studies revealed anaemia and thrombocytopenia along with neutrophilia with relative lymphopenia and monocytosis. A decreasing trend was observed in the levels of total protein and albumin, with an increase in the levels of globulin, alanine aminotransferase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, and creatinine. The ultrasonography studies revealed hepatosplenomegaly along with hyper-echogenicity in various organs. Proteinuria and haematuria were consistent, along with the presence of bile salts in the urine of affected dogs. Molecular confirmation from n-type PCR data using Ehrlichia-specific primers targeting the p28 gene (843 bp) was done, and the identified gene sequences submitted to NCBI databases have accession numbers OQ383671-OQ383674 and OP886674-OP886677. Ticks collected from dogs were identified morphologically through microscopy and scanning electron microscopy as Rhipicephalus sanguineus. [ABSTRACT FROM AUTHOR]

Introduction: Gouty nephropathy (GN) arises from factors like excessive purine intake, metabolic disorders or abnormal synthesis, and uric acid hypersaturation in the blood, leading to urate crystal deposition in kidney tissue. DaiTongXiao (DTX) is a remedy used by the Dai people of China. It shows efficacy in lowering uric acid levels and exhibits anti-inflammatory and kidney-protective properties. Methods: A GN rat model was induced using adenine and potassium oxonate. Following DTX administration, various parameters were assessed in urine, serum, and kidney tissue. Western blot analysis evaluated TLR4/MyD88/NF-κB signaling proteins, while immunofluorescence examined NF-κB nuclear expression. Results: DTX treatment improved kidney morphology, increased body weight, and kidney index and enhanced urinary levels of blood urea nitrogen (Bun), 24-h urinary protein, uric acid (UA), and allantoin in GN rats, reducing UA, Bun, creatinine (Cre), cystatin C (CysC), serum amyloid A (SAA), α1-microglobulin (MG), and β2-MG in serum analysis. Renal tissue assessments showed decreased xanthine oxidase (XOD), hydroxyproline (Hyp), α-smooth muscle actin (α-SMA), and collage type Ⅳ (COL-Ⅳ). Kidney damage severity was notably reduced. DTX lowered serum inflammatory factors like interleukin (IL) -18, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), transforming growth factor-β1 (TGF-β1), and IL-1β in the rat serum, reducing chemokine monocyte chemoattractant protein-1 (MCP-1) and adhesion factor vascular cell adhesion molecule-1(VCAM-1). Western blotting demonstrated the downregulation of TLR4/MyD88/NF-κB pathway proteins, and immunofluorescence revealed reduced NF-κB expression in renal tissue. Discussion: DTX exhibits significant anti-GN effects by modulating TLR4/MyD88/NF-κB pathway protein expression, reducing inflammatory factor release, and inhibiting GN progression. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to establish a predictive model of cognitive impairment in elderly people with diabetes. Methods: We analyzed a total of 878 elderly patients with diabetes who were part of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. The data were randomly divided into training and validation cohorts at a ratio of 6:4. The least absolute shrinkage and selection operator (LASSO) logistic regression analysis to identify independent risk factors and construct a prediction nomogram for cognitive impairment. The performance of the nomogram was assessed using receiver operating characteristic (ROC) curve and calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical utility of the nomogram. Results: LASSO logistic regression was used to screen eight variables, age, race, education, poverty income ratio (PIR), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum uric acid (SUA), and heart failure (HF). A nomogram model was built based on these predictors. The ROC analysis of our training set yielded an area under the curve (AUC) of 0.786, while the validation set showed an AUC of 0.777. The calibration curve demonstrated a good fit between the two groups. Furthermore, the DCA indicated that the model has a favorable net benefit when the risk threshold exceeds 0.2. Conclusion: The newly developed nomogram has proved to be an important tool for accurately predicting cognitive impairment in elderly patients with diabetes, providing important information for targeted prevention and intervention measures. [ABSTRACT FROM AUTHOR]

Background: Epstein-Barr virus (EBV) can be reactivated and proliferated with fatal outcome in immuno-compromised people, but the clinical consequences of EBV infection in patients with severe fever with thrombocytopenia syndrome (SFTS) remain uncertain. In this study, we investigated the infection rate, the influence and the early predictors of EBV infection in SFTS patients. Methods: In this retrospective study, SFTS patients who were treated in the First Affiliated Hospital of Nanjing Medical University from May 2011 to August 2021 were enrolled and divided into infected and non-infected groups. We compared the demographic characteristics, clinical manifestations and signs, laboratory tests and prognosis, and explored the risk factors of EBV infection by receiver operating characteristic (ROC) curve and logistic regression. Results: A total of 120 hospitalized SFTS patients with EBV-DNA testing were enrolled in this study. Patients with EBV infection had statistically significant higher mortality rate (32.0% vs. 11.43%, P = 0.005). Compared with the non-infected group, the EBV-infected group had higher levels of C-reactive protein (CRP), creatine-kinase (CK), fasting blood glucose (FBG), blood urea nitrogen (BUN), D-dimer, and CD56+ cell counts, lower levels of immunoglobulin G (IgG), IgM, complement 3 (C3), and C4. The proportion of patients with age ≥ 60 years and ferritin > 1500.0 ng/ml in the EBV-infected group was significantly higher than that in the non-infected group. The results of ROC analysis showed that the cut-off values of CRP, IgG, C3, C4, and CD56+ cell counts to predict EBV infection were 13.2 mg/l, 12.5 g/l, 1.1 g/l, 0.6 g/l, 0.3 g/l, and 94.0 cells/µl. Multivariable logistic analysis showed that age ≥ 60 years old, CRP > 13.2 mg/l, BUN > 5.4 mmol/l, ferritin > 1500.0 ng/ml, IgG < 12.5 g/l, IgM < 1.1 g/l, C4 < 0.3 g/l, and CD56+ cell counts > 94.0 cells/µl were the independent risk factors of EBV infection in SFTS patients. Conclusions: SFTS combined with EBV infection is associated with high morbidity and mortality. It is necessary to strengthen screening for EBV infection and its early predictive markers after admission in SFTS patients. [ABSTRACT FROM AUTHOR]

Background: Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment. Methods: Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle–Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis. Results: In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P < 0.00001], male gender [odds ratio (OR) = 1.47, 95% CI (1.07, 2.02), P = 0.02], and risk of death from severe pneumonia. The comorbidity of neoplasm [OR = 3.37, 95% CI (1.07, 10.57), P = 0.04], besides the presence of complications such as diastolic hypotension [OR = 2.60, 95% CI (1.45, 4.67), P = 0.001], ALI/ARDS [OR = 3.63, 95% CI (1.78, 7.39), P = 0.0004], septic shock [OR = 9.43, 95% CI (4.39, 20.28), P < 0.00001], MOF [OR = 4.34, 95% CI (2.36, 7.95), P < 0.00001], acute kidney injury [OR = 2.45, 95% CI (1.14, 5.26), P = 0.02], and metabolic acidosis [OR = 5.88, 95% CI (1.51, 22.88), P = 0.01] were associated with significantly higher risk of death among patients with severe pneumonia. Those who died, compared with those who survived, differed on multiple biomarkers on admission including serum creatinine [Scr: + 67.77 mmol/L, 95% CI (47.21, 88.34), P < 0.00001], blood urea nitrogen [BUN: + 6.26 mmol/L, 95% CI (1.49, 11.03), P = 0.01], C-reactive protein [CRP: + 33.09 mg/L, 95% CI (3.01, 63.18), P = 0.03], leukopenia [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], sodium < 136 mEq/L [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], albumin [− 5.17 g/L, 95% CI (− 7.09, − 3.25), P < 0.00001], PaO2/FiO2 [− 55.05 mmHg, 95% CI (− 60.11, − 50.00), P < 0.00001], arterial blood PH [− 0.09, 95% CI (− 0.15, − 0.04), P = 0.0005], gram-negative microorganism [OR = 2.56, 95% CI (1.17, 5.62), P = 0.02], and multilobar or bilateral involvement [OR = 3.65, 95% CI (2.70, 4.93), P < 0.00001]. Conclusions: Older age and male gender might face a greater risk of death in severe pneumonia individuals. The mortality of severe pneumonia may also be significantly impacted by complications such diastolic hypotension, ALI/ARDS, septic shock, MOF, acute kidney injury, and metabolic acidosis, as well as the comorbidity of neoplasm, and laboratory indicators involving Scr, BUN, CRP, leukopenia, sodium, albumin, PaO2/FiO2, arterial blood PH, gram-negative microorganism, and multilobar or bilateral involvement. Systematic review registration: PROSPERO Protocol Number: CRD 42023430684. [ABSTRACT FROM AUTHOR]

Background: Odisha experiencing sporadic outbreaks of Peste des petits ruminants (PPR) throughout the year. There is a scarcity of available literature on PPR in Odisha till today. This is the first ever detail investigative approach in the state undertaken with an objective to corelate the epidemiological risk factors, haemato-biochemical and pathological changes in natural field outbreaks occurring in eight different districts. Methods: Fourteen field outbreaks of PPR were evaluated clinically as well as epidemiologically and confirmed through polymerase chain reaction (PCR). Blood, serum, faecal and tissue samples were collected to observe haemato-biochemical and pathomorphological changes to asses disease severity. Result: Present study concluded an overall mortality rate of 46.81%. Chi-square analysis revealed significant highest prevalence among 7-12 months (46.13%) age, Ganjam breed (45.51%) and females (80.49%). Frequent migration among the border areas along with poor management and helminthic infection was major precipitating factor. There was polycythemia along with neutrophilia and lymphopenia. Significant increase in alanine transaminase (ALT), aspartate aminotransferase (AST), K+ and Ca+2 along with creatinine, urea and blood urea nitrogen (BUN) BUN was observed in affected flocks. Antero-ventral consolidation of lungs, syncytia and presence of both eosinophilic intranuclear and intracytoplasmic inclusion bodies were major pathological changes. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office 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.)

Objective. To evaluate the beneficial and adverse effects of breviscapine injection in combination with antihypertensive drugs for treating hypertensive nephropathy in clinical practice. Methods. We searched PubMed, the Cochrane Library, Embase, CNKI, Sino Med, VIP, and Wanfang Data for relevant literature. The timeframe of retrieval was set from the founding date of each database to September 28, 2018. Results. Fourteen papers were included in this study. The quality of all the studies included was determined to be low. All studies were conducted with Chinese populations. Meta-analysis showed that, compared with single-use antihypertensive drugs, using breviscapine injection in combination with antihypertensive drugs to treat hypertensive nephropathy can reduce serum creatinine (Scr) [WMD = –35.16, 95% CI(–50.01, –20.31), P ≤ 0.001], blood urea nitrogen (BUN) [WMD = –2.00, 95% CI(–3.07, –0.94), P ≤ 0.001], 24-hour urinary total protein (24 h UTP) [WMD = –0.04, 95% CI(–0.05, –0.02), P ≤ 0.001], and the beta-2-microglobulin (B2M) [WMD = –0.09, 95% CI(–0.11, –0.07), P ≤ 0.001], improve creatinine clearance rate (Ccr) [WMD = 7.84, 95% CI(5.20, 10.49), P ≤ 0.001], and increase the clinical efficacy [RR = 1.27, 95% CI(1.05, 1.53), P = 0.014], but does not lower systolic blood pressure (SBP) [WMD = –1.02, 95% CI(–2.88, 0.84), P = 0.281]. There was no significant difference in adverse events between experimental groups and control groups. Conclusion. Breviscapine injection in combination with antihypertensive drugs can improve clinical efficacy and Ccr and reduce Scr, BUN, 24 h UTP, and B2M in patients with hypertensive nephropathy. The present meta-analysis indicated that breviscapine injection can serve as a renal protective effect to patients with hypertensive nephropathy. However, the evidence of methodological quality and sample sizes is weak, and thus, further standardized research is required. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office 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.)

Shenkang injection (SKI) has been widely used in China for many years for the treatment of kidney disease. The objective of this systematic review was to assess the efficacy of Shenkang injection for the treatment of acute kidney injury (AKI). A search was conducted across seven databases, encompassing data from the inception of each database through October 8th, 2023. Randomized controlled trials comparing SKI-treated AKI patients with control subjects were extracted. The main outcome measure was serum creatinine (SCr) levels. Secondary outcomes included blood urea nitrogen (BUN), serum cystatin C (CysC), 24-h urine protein (24 h-Upro) levels, APACHE II score and adverse reactions. This meta-analysis included eleven studies, and the analysis indicated that, compared with the control group, SKI significantly decreased SCr [WMD = −23.31, 95% CI (-28.06, −18.57); p < 0.001]; BUN [WMD = −2.07, 95% CI (-2.56, −1.57); p < 0.001]; CysC [WMD = −0.55, 95% CI (-0.78, −0.32), p < 0.001]; 24-h urine protein [WMD = −0.43, 95% CI (-0.53, −0.34), p < 0.001]; and the APACHE II score [WMD = −3.07, 95% CI (-3.67, −2.48), p < 0.001]. There was no difference in adverse reactions between the SKI group and the control group [RR = 1.32, 95% CI (0.66, 2.63), p = 0.431]. The use of SKI in AKI patients may reduce SCr, BUN, CysC, 24-h Upro levels, and APACHE II scores in AKI patients. The incidence of adverse reactions did not differ from that in the control group. Additional rigorous clinical trials will be necessary in the future to thoroughly evaluate and establish the effectiveness of SKI in the treatment of AKI. [ABSTRACT FROM AUTHOR]

Background: Renal hypoxia plays a key role in the progression of chronic kidney disease (CKD). Shen Shuai II Recipe (SSR) has shown good results in the treatment of CKD as a common herbal formula. This study aimed to explore the effect of SSR on renal hypoxia and injury in CKD rats. Methods: Twenty-five Wistar rats underwent 5/6 renal ablation/infarction (A/I) surgery were randomly divided into three groups: 5/6 (A/I), 5/6 (A/I) + losartan (LOS), and 5/6 (A/I) + SSR groups. Another eight normal rats were used as the Sham group. After 8-week corresponding interventions, blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) was performed to evaluate renal oxygenation in all rats, and biochemical indicators were used to measure kidney and liver function, hemoglobin, and proteinuria. The expression of fibrosis and hypoxia-related proteins was analyzed using immunoblotting examination. Results: Renal oxygenation, evaluated by BOLD-fMRI as cortical and medullary T2* values (COT2* and MET2*), was decreased in 5/6 (A/I) rats, but increased after SSR treatment. SSR also downregulated the expression of hypoxia-inducible factor-1α (HIF-1α) in 5/6 (A/I) kidneys. With the improvement of renal hypoxia, renal function and fibrosis were improved in 5/6 (A/I) rats, accompanied by reduced proteinuria. Furthermore, the COT2* and MET2* were significantly positively correlated with the levels of creatinine clearance rate (Ccr) and hemoglobin, but negatively associated with the levels of serum creatinine (SCr), blood urea nitrogen (BUN), serum cystatin C (CysC), serum uric acid (UA), 24-h urinary protein (24-h Upr), and urinary albumin:creatinine ratio (UACR). Conclusion: The degree of renal oxygenation reduction is correlated with the severity of renal injury in CKD. SSR can improve renal hypoxia to attenuate renal injury in 5/6 (A/I) rats of CKD. [ABSTRACT FROM AUTHOR]

Nanostructures composed of liposomes and polydopamine (PDA) have demonstrated efficacy as carriers for delivering plasmids, effectively alleviating renal cell carcinoma. However, their role in acute kidney injury (AKI) remains unclear. This study aimed to investigate the effects of the plasmid-encoded lncRNA-OIP5-AS1@PDA nanoparticles (POP-NPs) on renal ischemia/reperfusion (RI/R) injury and explore the underlying mechanisms. RI/R or OGD/R models were established in mice and HK-2 cells, respectively. In vivo, vector or POP-NPs were administered (10 nmol, IV) 48 h after RI/R treatment. In the RI/R mouse model, the OIP5-AS1 and Nrf2/HO-1 expressions were down-regulated, while miR-410-3p expression was upregulated. POP-NPs treatment effectively reversed RI/R-induced renal tissue injury, restoring altered levels of blood urea nitrogen, creatinine, malondialdehyde, inflammatory factors (IL-8, IL-6, TNF-α), ROS, apoptosis, miR-410-3p, as well as the suppressed expression of SOD and Nrf2/HO-1 in the model mice. Similar results were obtained in cell models treated with POP-NPs. Additionally, miR-410-3p mimics could reverse the effects of POP-NPs on cellular models, partially counteracted by Nrf2 agonists. The binding relationship between OIP5-AS1 and miR-410-3p, alongside miR-410-3p and Nrf2, has been substantiated by dual-luciferase reporter and RNA pull-down assays. The study revealed that POP-NPs can attenuate RI/R-induced injury through miR-410-3p/Nrf2 axis. These findings lay the groundwork for future targeted therapeutic approaches utilizing nanoparticles for RI/R-induced AKI. [ABSTRACT FROM AUTHOR]

A urea quantification method integrated with a pipette-tip-based biosensor and a smartphone was developed for the on-site diagnosis of blood urea nitrogen. When a sample solution containing phenol red is drawn into a pipette tip with urease immobilized on its inner wall, the color of the solution changes owing to an enzymatic reaction. The urea concentration can be quantified by photographing the pipette tip with a smartphone and quantifying the color intensity of the solution. In actual urea measurements, the detection limit (3σ) was estimated to be 1.3 mg/dL, indicating that the method has sufficient performance to quantify urea in serum. Furthermore, the method was found to reduce sample consumption and analysis time to 1/10 and 1/3, respectively, compared with conventional methods using microwell plates. This method requires only a micropipette and a smartphone to carry out measurements and does not require bench-top precision equipment or special training. Therefore, the method is expected to develop into a practical analytical platform for biomarker diagnostics that can be used in the field. [ABSTRACT FROM AUTHOR]

Objective To assess the outcome of patients with cancer-related sepsis requiring continuous renal replacement therapy (CRRT) in a single-center pediatric intensive care unit (PICU). Method Children with sepsis who necessitate CRRT from January 2017 to December 2021 were enrolled. The patients with leukemia/lymphoma or solid tumors were defined as underlying cancer. Multivariate logistic regression analysis was performed to identify the death risk factors in patients with cancer-related sepsis. Results A total of 146 patients were qualified for inclusion. Forty-six (31.5%) patients with cancer-related sepsis and 100 (68.5%) non-cancer-related sepsis. The overall PICU mortality was 28.1% (41/146), and mortality was significantly higher in cancer-related sepsis patients compared with non-cancer patients (41.3% vs. 22.0%, p = 0.016). Need mechanical ventilation, p-SOFA, acute liver failure, higher fluid overload at CRRT initiation, hypoalbuminemia, and high inotropic support were associated with PICU mortality in cancer-related sepsis patients. Moreover, levels of IL-6, total bilirubin, creatinine, blood urea nitrogen, and international normalized ratio were significantly higher in non-survivors than survivors. In multivariate logistic regression analysis, pediatric sequential organ failure assessment (p-SOFA) score (OR:1.805 [95%CI: 1.047–3.113]) and serum albumin level (OR: 0.758 [95%CI: 0.581 -0.988]) were death risk factors in cancer-related sepsis receiving CRRT, and the AUC of combined index of p-SOFA and albumin was 0.852 (95% CI: 0.730–0.974). Conclusion The overall PICU mortality is high in cancer-related sepsis necessitating CRRT. Higher p-SOFA and lower albumin were independent risk factors for PICU mortality. [ABSTRACT FROM AUTHOR]

Neonatal calves are prone to gastrointestinal infections and microbial dysbiosis that lead to high morbidity and mortality. Prebiotics can be used to mitigate the adverse effects of gut diseases and microbial dysbiosis. Forty male Holstein-Friesian calves (2 ± 1 day old) were divided into four dietary treatments: control (milk without prebiotics), YCW-2, YCW-4 (milk containing 2 or 4 g/day/calf of yeast cell wall, respectively), and cMOS (milk containing commercial mannan-oligosaccharides 4 g/day/calf). Milk intake, feed intake, and health scores were recorded daily, whereas body weight, dry matter intake (DMI), and body measurements were recorded weekly. Feed efficiency (FE) was determined at the end of the trial (eight weeks). Cell-mediated immunity (CMI) was assessed by the topical application of dinitrochlorobenzene. Blood samples were collected fortnightly to determine glucose, non-esterified fatty acid (NEFA), blood urea nitrogen (BUN), and beta-hydroxybutyric acid (ßHBA). Cell wall supplemented calves had significantly higher (P < 0.05) final body weights, DMI, and body measurements along with improved (P < 0.05) faecal scores. Feed intake was higher (P < 0.05) in both the YCW-supplemented calves. Glucose was lower (P < 0.001), whereas BUN and ßHBA were significantly higher in the YCW-2 animals. No differences were observed in FE, CMI, and NEFA between all the experimental animals. The yeast cell wall (2 g) may have the potential to improve the growth performance and health status of neonatal calves. [ABSTRACT FROM AUTHOR]

Background: Drawing on prospective data from the National Health and Nutrition Examination Survey (NHANES), our goal was to construct and validate a 5-year survival prediction model for individuals with cognitive impairment (CI). Methods: This study entailed a prospective cohort design utilizing information from the 2011-2014 NHANES dataset, encompassing individuals aged 40 years or older, with updated mortality status as of December 31, 2019. Predictive models within the derivation and validation cohorts were assessed using logistic proportional risk regression, column-line plots, and least absolute shrinkage and selection operator (LASSO) binomial regression models. Results: The study enrolled a total of 1,439 participants (677 men, mean age 69.75 ± 6.71 years), with the derivation and validation cohorts consisting of 1,007 (538 men) and 432 (239 men) individuals, respectively. The 5-year mortality rate stood at 16.12% (n = 232). We devised a 5-item column-line graphical model incorporating age, race, stroke, cardiovascular disease (CVD), and blood urea nitrogen (BUN). The model exhibited an area under the curve (AUC) of 0.772 with satisfactory calibration. Internal validation demonstrated that the column-line graph model displayed strong discrimination, yielding an AUC of 0.733, and exhibited good calibration. Conclusion: To sum up, our study successfully developed and internally validated a 5-item nomogram integrating age, race, stroke, cardiovascular disease, and blood urea nitrogen. This nomogram exhibited robust predictive performance for 5-year mortality in individuals with CI, offering a valuable tool for prognostic evaluation and personalized care planning. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate colloids and crystalloids used in perioperative fluid therapy for cardiac surgery patients to further investigate the optimal management strategies of different solutions. Method: RCTs about adult surgical patients allocated to receive perioperative fluid therapy for electronic databases, including Ovid MEDLINE, EMBase, and Cochrane Central Register of Controlled Trials, were searched up to February 15, 2023. Results: None of the results based on network comparisons, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay, were statistically significant. Due to the small number of included studies, the results, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, are from the direct comparison. For transfusion of RBCs, significant differences were observed in the comparisons of 3% gelatine vs. 6% HES 200/0.5, 4% albumin vs. 5% albumin, 4% gelatine vs. 5% albumin, 5% albumin vs. 6% HES 200/0.5, and 6% HES 130/0.4 vs. 6% HES 200/0.5. In transfusion of FFP, significant differences were observed in comparisons of 3% gelatine vs. 4% gelatine, 3% gelatine vs. 6% HES 200/0.5, 5% albumin vs. 6% HES 200/0.5, 4% gelatine vs. 5% albumin, 4% gelatine vs. 6% HES 200/0.4, and 6% HES 130/0.4 vs. 6% HES 200/0.5. For urinary output at 24 h after surgery, the results are deposited in the main text. Conclusion: This study showed that 3% gelatin and 5% albumin can reduce the transfuse RBC and FFP. In addition, the use of hypertonic saline solution can increase urine output, and 5% albumin and 6% HES can shorten the length of ICU stay. However, none of the perioperative fluids showed an objective advantage in various outcomes, including mortality, transfuse PLA, postoperative chest tube output over the first 24 h following surgery, and length of hospital stay. The reliable and sufficient evidences on the injury of the kidney, including acute kidney injury, serum creatinine, serum microglobulin, and blood urea nitrogen, was still lacking. In general, perioperative fluids had advantages and disadvantages, and there were no evidences to support the recommendation of the optimal perioperative fluid for cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: The relationships between BUNCr (blood urea nitrogen and creatinine ratio) and cognitive function, as well as depressive symptoms, remain unclear. We aim to investigate the association between BUNCr and cognition, as well as depressive symptoms, and to identify the mechanisms underlying these relationships. Methods: We utilized data from the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020. Cognitive function was assessed using the Telephone Interview of Cognitive Status (TICS) scale, while depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). We employed multivariate linear regression models to examine the association between BUNCr and cognitive function, as well as depressive symptoms. Additionally, causal mediation analysis was conducted to identify potential mediation effects of depressive symptoms between BUNCr and cognition. Results: We observed a negative association between BUNCr and cognitive function (coefficient: -0.192; 95% confidence interval [CI]: -0.326 ∼ -0.059) and a positive relationship between BUNCr and depressive symptoms (coefficient: 0.145; 95% CI: 0.006 ∼ 0.285). In addition, the causal mediation analysis revealed that depressive symptoms (proportion mediated: 7.0%) significantly mediated the association between BUNCr and cognition. Conclusion: Our study has unveiled that BUNCr is inversely associated with cognitive function and positively linked to depressive symptoms. Moreover, we found that depressive symptoms significantly mediated the association between BUNCr and cognition. These findings provide new evidence and insights for the prevention and management of cognitive function and dementia. [ABSTRACT FROM AUTHOR]