Search

Flexible capacitive pressure sensors with a simple structure and low power consumption are attracting attention, owing to their wide range of applications in wearable electronic devices. However, it is difficult to manufacture pressure sensors with high sensitivity, wide detection range, and low detection limits. We developed a highly sensitive and flexible capacitive pressure sensor based on the porous Ecoflex, which has an aligned airgap structure and can be manufactured by simply using a mold and a micro-needle. The existence of precisely aligned airgap structures significantly improved the sensor sensitivity compared to other dielectric structures without airgaps. The proposed capacitive pressure sensor with an alignment airgap structure supports a wide range of working pressures (20–100 kPa), quick response time (≈100 ms), high operational stability, and low-pressure detection limit (20 Pa). Moreover, we also studied the application of pulse wave monitoring in wearable sensors, exhibiting excellent performance in wearable devices that detect pulse waves before and after exercise. The proposed pressure sensor is applicable in electronic skin and wearable medical assistive devices owing to its excellent functional features. [ABSTRACT FROM AUTHOR]

Abstract Printed organic sensors are of significant importance owing to their simplicity, low cost, easy fabrication and solution processability. However, organic sensors often suffer from the drawback of performance degradation when exposed to ambient environment. In this study, polyvinyl alcohol (PVA) is used as the functional layer of a temperature sensor and is encapsulated by aluminum oxide (Al 2 O 3) deposited through spatial atmospheric atomic layer deposition system (SAALD). The encapsulating layer of Al 2 O 3 was pure, atomically thin and highly reliable. Fabricated organic temperature sensor is based on a conductive and uniform interdigitated pattern deposited on a flexible polyethylene naphthalate substrate through advanced printing technology of reverse offset. Thin film of PVA is used as the temperature sensitive functional layer deposited through electrohydrodynamic atomization followed by Al 2 O 3 encapsulation. The developed sensors were tested in the temperature range of 25 °C to 90 °C with relative humidity reaching up to 75% relative humidity. The obtained results exhibited that Al 2 O 3 encapsulation deposited through SAALD significantly enhanced the linearity, repeatability, endurance (50 cycles), retention (2 months) and lifetime of PVA based temperature sensor as compared with the non-encapsulated sensor hence, protecting the organic device from performance degradation. Highlights • Lifetime of organic temperature sensor has been enhanced through encapsulation. • Electrical, mechanical, chemical, and morphological characterizations are included. • The device is encapsulated with Al 2 O 3 thin film deposited through SAALD system. • Encapsulated sensor displayed better results than non-encapsulated sensor. • The obtained results were highly stable and reproducible. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Novel proposed micro-mixers designs are analyzed for mixing index/mixing efficiency. • Effect of Reynolds number on mixing index is investigated. • Effect of pressure drop on mixing index is investigated. • Relationship between Reynolds number and pressure drop is investigated. • Based on this analysis YRCSAR design is concluded having better mixing index. Abstract Three representative types of Y-shaped split and recombination three-dimensional passive micromixers are analyzed for mixing efficiency both experimentally and by numerical simulation. These designs are important because of simple fabrication and better mixing ability. The flow and mixing capability of these mixers are numerically investigated for Reynolds number, in the range of 0.5–100. Mixing index and pressure drop of each micro-mixer design are evaluated in COMSOL 5.2a. All Proposed designs mixing index line graph and images are clearly showing that mixing is much improved as compared to straight mixer YSSAR. It is due to chaotic advection and Dean Flow effect in YCSAR, YRCSAR, and YRSAR that transverse flow mechanism enhance the mixing index. The mixing index of YRCSAR, having both circular and rhombus mixing units is 99% at Reynolds number 100 superior in mixing performance as compared other proposed micro-mixers. Mixers chips are fabricated from borosilicate glass and liquid silicone elastomer material. Red and yellow dye was used for evaluating the mixing performance experimentally. Simulation and experimental images of analyzed micro-mixers as well as the line plots, both shows that with an increase in Reynolds number mixing index increases. As a result of the increase in Reynolds number, there is an increase in the chaotic advection and Dean Flow effect, which creates rotations and vortices and hence improve the mixing index. There is a little difference in experimental and simulation results values but the overall trends are consistent in both cases. [ABSTRACT FROM AUTHOR]

This article begins with an examination of the role of social services as the key instrument of social investment strategy, presenting an empirical analysis of its impact on economic performance. A pooled time series, cross-section analysis was conducted with the data of 15 welfare states from 1990 to 2007 under the 'social investment hypothesis' that more social service orientedness brings about a greater positive effect on the economy. The results show that a larger share of social service spending in the total social expenditure - more social service orientedness - contributes to economic growth and labour market performance, whereas a larger aggregate size of the welfare state may have a negative effect on employment. In conclusion, this study suggests that the relatively ambiguous welfare strategy of social investment could be clarified as a 'transition from income security to livelihood security' in which emphasis is placed on social service. Key Practitioner Message: ● This study suggests that the key instrument of social investment strategy is social service; ● The results show that more social service orientedness contributes to economic growth and labour market performance. [ABSTRACT FROM AUTHOR]

In this paper, we propose a method to recognize human actions independently of viewpoints by developing 4D space–time features which can generalize the information from a finite number of views in training phase so as to show a satisfactory performance in arbitrary testing views. This 4D space–time interest points (4D-STIPs, [ x , y , z , t ] ) are extracted using 3D space volumes reconstructed from images of a finite number of different views. Since the proposed features are constructed using volumetric information, the features for arbitrary 2D space viewpoint in testing can be generated by projecting the 3D space volumes and 4D-STIPs on corresponding test image planes. This enables action recognition in any camera viewpoint even after training with images from only a finite number of views. We also propose the variant of 3D space–time interest points, which take into account the simultaneous gradient variation in all 3 dimensions to focus on the motion of important spatial corner points. 3D space volumes and 4D-STIPs can be projected to arbitrary viewpoints for training each action to get generalization capability of the classifier. With these projected features, we construct motion history images and non-motion history images which encode the moving and non-moving parts of an action respectively. After reducing the feature dimension, the final features are learned by support vector data description method. In experiments, we train the models using IXMAS dataset constructed from five views and test them with a new SNU dataset made for evaluating the generalization performance for arbitrary view videos. [ABSTRACT FROM AUTHOR]

This study investigated public attitudes towards pension spending in welfare states. By utilising a dataset covering 21 different Western European countries and conducting a multi-level analyses, three main findings resulted. First, as the welfare status model suggests, the status of welfare duties as well as the status of welfare rights proved to play a key role in shaping the political cleavages over public pensions at both macro- and micro-levels. Second, age and gender also seem to be significant sources of cleavage in addition to class-related variables. Finally, the study examined empirically the interaction effect of age and class-related factors to reveal that class-based interests offset generational interests. [ABSTRACT FROM AUTHOR]

Heart failure (HF) was induced by ligation of the left anterior descending artery (LAD). Left ventricular end-diastolic pressure (LVEDP) >25 mmHg (at day 23 after LAD ligation) was the inclusion criterion. The rats were divided into three groups: sham-operated (Sham, n = 23, LVEDP: 5.6 ± 0.6 mmHg), HF (n = 14, LVEDP: 29.4 ± 1.4 mmHg), and candesartan (1 mg·kg-1·day-1 sc)-treated HF (HF + Can, n = 9, LVEDP: 29.2 ± 1.2 mmHg). After 7 days (i.e., 29 days after LAD ligation) semiquantitative immunoblotting revealed increased abundance of inner medulla aquaporin-2 (AQP2) and AQP2 phosphorylated at Ser256 (p-AQP2) in HF. There was also markedly enhanced apical targeting of AQP2 and p-AQP2 in inner medullary collecting duct (IMCD) in HF compared with Sham rats, shown by immunocyto-chemistry. Candesartan treatment significantly reversed the increases in both AQP2 and p-AQP2 expression and targeting. In contrast, there were only modest changes in other collecting duct segments. Semiquantitative immunoblots revealed increased expression of type 3 N+/H+ exchanger (NHE3) and Na+-K+-2Cl- cotransporter (NKCC2) in kidneys from HF compared with Sham rats: both effects were reversed or prevented by candesartan treatment. The protein abundance of α-epithelial sodium channel (α-ENaC) was increased while β-ENaC and γ-ENaC expression was decreased in the cortex and outer stripe of the outer medulla in HF compared with Sham rats, which was partially reversed by candesartan treatment. These findings strongly support an important role of angiotensin II in the pathophysiology of renal water and sodium retention associated with HF. [ABSTRACT FROM AUTHOR]

1. Effects of non-steroidal anti-inflammatory drugs on the local atrial natriuretic peptide (ANP) and nitric oxide (NO) systems in the kidney were investigated. 2. Male Sprague-Dawley rats were treated with indomethacin (5 mg/kg, every 12 h, i.p.) for 2 days. The expression of ANP and natriuretic peptide receptor-A (NPR-A) mRNA was determined in the kidney, as was that of endothelial NO synthase (NOS) proteins. Particulate and soluble guanylyl cyclase activities were determined separately. 3. Following treatment with indomethacin, urinary sodium excretion decreased significantly. Although the renal expression of ANP was not changed significantly, that of NPR-A decreased significantly. The expression of NOS increased significantly. Particulate guanylyl cyclase activity was decreased, whereas the activity of soluble guanylyl cyclase was increased. The catalytic activity of Na+/K+-ATPase was increased, with no significant changes in its expression. The expression of the type 3 Na/H exchanger and Na–K−2CL cotransporters increased significantly. 4. The indomethacin-induced decrease in urinary sodium excretion may be attributed, at least in part, to decreased activity of the local ANP/cGMP system. The increased activity of the NO/cGMP system may be a compensatory response to the diminished activity of the prostaglandin system. [ABSTRACT FROM AUTHOR]

Objective: We investigated whether regulation of aquaporin (AQP) water channels is altered in the ureteral-obstructed kidney. Material and Methods: Male Sprague-Dawley rats were unilaterally obstructed of their left proximal ureters for 48 h. The protein expression of AQP1-3 channels was determined in the kidney by Western blot analysis. The expression of AQP2 was also determined by immunohistochemistry. In order to specifically determine primary impairment of the pathway leading to an altered regulation of AQP channels stimulated by the arginine vasopressin (AVP)/cyclic adenosine monophosphate (cAMP) pathway, the catalytic activity and protein expression of different parts of the adenylyl cyclase complex were separately determined. Results: In the previously obstructed kidney, urinary osmolality and free water reabsorption were greatly decreased. The expression of AQP2 proteins was decreased in the cortex, outer medulla and inner medulla. Immunohistochemistry also showed a marked decrease in AQP2 expression. The expression of AQP1 and AQP3 was decreased in the outer medulla and inner medulla. cAMP generation in response to AVP, sodium fluoride or forskolin was greatly decreased. The expression of Gs3 and adenylyl cyclase VI proteins was decreased. The contralateral kidney showed minimal or no changes in these parameters. Conclusions: The reduced abundance of AQP water channels may at least partly account for the urinary concentration defect in the ureteral-obstructed kidney. The primary point of impairment of AQP channels regulated by the AVP/cAMP pathway may lie at the level of the catalytic unit of adenylyl cyclase. [ABSTRACT FROM AUTHOR]

The present study was aimed to determine the molecular mechanisms underlying the water retention associated with hypothyroidism. Male Sprague–Dawley rats (200–220 g) were experimentally induced of hypothyroidism by treatment with methimazole in drinking water (0.04%) for 8 weeks. In the experimental group, serum concentrations of thyroxine and triiodothyronine were significantly decreased. The expression of aquaporin 2 (AQP2) was significantly increased in the cortex, outer medulla, and inner medulla of the kidney. The expression of AQP1 as well as that of AQP3 was significantly increased in the cortex, though not in the medulla. The adenylyl cyclase activity provoked by arginine vasopressin (AVP), sodium fluoride, or forskolin was blunted in the hypothyroid kidney, while plasma levels of AVP were not significantly changed. The increased expression of AQP1–3 channels may in part account for the water retention in hypothyroidism. [Copyright &y& Elsevier]

Objectives: Whether the natriuresis in the previously ureteral obstructed kidney may be related to an altered regulation of local atrial natriuretic peptide (ANP) was investigated. Materials and Methods: Male Sprague-Dawley rats were unilaterally obstructed of the left ureters for 48 hours. The left and right ureters were separately cannulated to collect urine samples. In some rats, both kidneys were removed without releasing the obstruction. Control rats were treated the same except that no ureteral obstruction was made. The mRNA expression of ANP and natriuretic peptide receptor (NPR)-A was determined in the kidney by reverse transcription-polymerase chain reaction. The guanylyl cyclase activity was measured by the amount of cGMP generated in response to ANP. Plasma levels of ANP were measured by radioimmunoassay. Results: The ureteral obstruction did not significantly affect the plasma ANP levels. In the obstructed kidney, the creatinine clearance was decreased, while the fractional excretion of sodium increased. The expression of ANP mRNA was increased in the obstructed kidney. The NPR-A mRNA expression was not altered in the glomerulus, but was decreased in the papilla of the obstructed kidney. Nor was the guanylyl cyclase activity in the glomerulus altered. Although the guanylyl cyclase activity in the papilla was significantly decreased in the obstructed kidney, it was rapidly resumed upon releasing the obstruction. Conclusions: An increased local expression of ANP may, at least in part, account for the natriuresis in the previously ureteral obstructed kidney. [ABSTRACT FROM AUTHOR]

Increased expression of atrial natriuretic peptide in the kidney of rats with bilateral ureteral obstruction. Background. Whether the postobstructive diuresis can be related to an altered regulation of local atrial natriuretic peptide (ANP) in the kidney was investigated. Methods. Three groups of rats had both of their ureters obstructed for 48 hours. The kidneys were taken without releasing the obstruction in one group [bilateral ureteral obstruction (BUO)]. The obstruction was released in the other two groups and the animals were kept for 4 and 24 hours thereafter to collect urinary data (BUR-4 and BUR-24, respectively). Plasma and urine ANP levels were measured by radioimmunoassay. The mRNA expression of ANP, natriuretic peptide receptor-A (NPR-A), and NPR-C was determined by reverse transcription-polymerase chain reaction. ANP receptors were also quantitated by in vitro autoradiography. The activity of guanylyl cyclase was determined by the amount of cGMP generated in response to ANP. Results. Urinary volume and sodium excretion increased in BUR-4, along with the ANP mRNA expression in the kidney and the urinary ANP excretion. The ANP excretion positively correlated with the urinary volume and sodium excretion. The mRNA expression of both NPR-A and NPR-C was decreased by BUO, the latter being far more prominently affected. The maximal binding capacity of radiolabeled ANP was decreased in the glomerulus and papilla in BUO. Not only the urinary parameters but also the mRNA expression of ANP, NPR-A, and NPR-C were comparable between BUR-24 and control rats. ANP-stimulated cGMP generation was reduced in the glomerulus and papilla in BUO animals, which was rapidly resumed following the release of the obstruction. Conclusions. Postobstructive diuresis may be due partially to an increased ANP activity in the kidney. [ABSTRACT FROM AUTHOR]

• Integrated micro temperature and humidity sensors. • Real time temperature compensation for humidity sensors output. • Liquid mechanical exfoliation of MoS2 to achieve 2D flakes and particles suspended in PEO polymer matrix. • Detailed investigation of working principle and sensing mechanism. • Micron level size compatible with integration in MEMS based commercial devices. Percentage relative humidity is dependent on environmental temperature but the fact is ignored in most of research on humidity sensors. Secondly, the physical size of sensors should be small enough to enable integration on a commercial microchip. In this work, an integrated micro temperature plus humidity sensor system is presented that compensates for the effect of surrounding temperature on the output resistance of humidity sensor. The sensors were fabricated using Electrohydrodynamic drop-on-demand (EHD-DOD) printing for the electrodes, and Electrospray deposition (ESD) for active layer fabrication of humidity sensors. Electrode line widths were 10 μm while the combined area of both sensors was ∼2 mm2. Meander type silver patterns were used as resistive temperature sensors and interdigitated transducer (IDT) electrodes were used for humidity sensors. The active layer of humidity sensors was fabricated using a novel composite of Polyethylene Oxide (PEO) and 2D Molybdenum disulfide (MoS 2) flakes to achieve a highly sensitive (85 kΩ/%RH) and almost linear response for a wide detection range (0–80% RH) of relative humidity. A mathematical model relating the outputs of both sensors was developed to compensate for the effects of temperature. The system presents optimal solution for commercialization ready temperature compensated integrated micro temperature and humidity sensors fabricated through all printing techniques. [ABSTRACT FROM AUTHOR]

Functional thin film of strontium titanate/polyvinyl alcohol (SrTiO 3 -PVA) hybrid nanocomposite was sandwiched between silver (Ag) electrodes for the application of resistive random access memory (RRAM). Bottom Ag electrodes were patterned using high resolution reverse offset printing system while the hybrid composite thin film and the top Ag electrode were deposited through electro-hydrodynamic (EHD) atomization and EHD patterning respectively. RRAM behavior of SrTiO 3 memory device has not been reported on a flexible substrate due to its brittle nature therefore, in this study we have successfully evaluated its mechanical robustness by forming its nanocomposite with highly flexible PVA polymer. The fabricated device showed bipolar, rewritable and nonvolatile memory behavior at low operating voltage. The bistable resistive switching behavior had off/on ratio of ~30, retention time of 8.64 × 104 s and electrical endurance of 500 operating cycles. The device illustrated mechanical robustness when subjected to 500 bend cycles and varying bending diameters. Image 100539 • A flexible resistive memory device was fabricated using hybrid composite thin film. • SrTiO 3 +PVA thin film was deposited using EHDA spray deposition technique. • All-printed memory device exhibited improved electrical and mechanical endurance. • It showed bistable, rewritable, nonvolatile memory behavior at low working voltage. • The device showed excellent mechanical robustness when tested for 500 bend cycles. [ABSTRACT FROM AUTHOR]

While the relationship between circulating osteoprotegerin (OPG) and cardiovascular events is well-established in the general population, its association with cardiovascular risks in chronic kidney disease (CKD) patients remains less robust. This study hypothesized that elevated circulating OPG levels might be associated with an increased risk of major adverse cardiac events (MACE) in CKD patients, a total of 2,109 patients with CKD stages 1 through pre-dialysis 5 from the KNOW-CKD cohort were categorized into quartiles based on serum OPG levels. The primary outcome of the study was 3-point MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, or cardiac death. The median follow-up duration was 7.9 years. The cumulative incidence of 3-point MACE significantly varied across serum OPG levels in Kaplan–Meier curve analysis (P < 0.001, log-rank test), with the highest incidence observed in the 4th quartile. Cox regression analysis indicated that, relative to the 1st quartile, the risk of 3-point MACE was significantly higher in the 3rd (adjusted hazard ratio 2.901, 95% confidence interval 1.009 to 8.341) and the 4th quartiles (adjusted hazard ratio 4.347, 95% confidence interval 1.410 to 13.395). In conclusion, elevated circulating OPG levels are associated with adverse cardiovascular outcomes in pre-dialysis CKD patients. [ABSTRACT FROM AUTHOR]

SUMMARY 1. The effects of intracerebroventricular (i.c.v.) infusion of Dendroaspis natriuretic peptide (DNP) on renal function were examined in anaesthetized rats. The results were compared with those obtained following intravenous (i.v.) infusion of the same dose of DNP. 2. Urine volume was increased four- to six-fold over basal values by i.c.v. infusion of DNP (6 pmol/min). Urine osmolality was decreased, whereas sodium excretion was not significantly altered. Intravenous infusion of the same dose of DNP had little effect on urinary water excretion. Neither arterial pressure nor heart rate was changed significantly by either i.v. or i.c.v. infusion of DNP. Glomerular filtration rate, measured by creatinine clearance, remained unaltered. 3. The diuretic response to i.c.v. DNP was markedly attenuated in rats that were deprived of their water supply for 3 days before the experiment. 4. These results suggest that DNP can act within the central nervous system to increase renal water excretion. [ABSTRACT FROM AUTHOR]

Introduction: End-stage renal disease (ESRD) is a growing disease worldwide, including Korea. This is an important condition that affects patient outcome. To provide optimal management for mineral disturbance, vascular calcification, and bone disease in ESRD patients, the Korean dialysis cohort for mineral, vascular calcification, and fracture (ORCHESTRA) study was conducted by enrolling Korean dialysis patients. Methods: Sixteen university-affiliated hospitals and one Veterans' Health Service Medical Center participated in this study. This prospective cohort study enrolled approximately 900 consecutive patients on dialysis between May 2019 and January 2021. Enrolled subjects were evaluated at baseline for demographic information, laboratory tests, radiologic imaging, and bone mineral densitometry (BMD) scans. After enrollment, regular assessments of the patients were performed, and their biospecimens were collected according to the study protocol. The primary outcomes were the occurrence of major adverse cardiovascular events, invasive treatment for peripheral artery disease, and osteoporotic fractures. The secondary outcomes were hospitalization for cerebrovascular disease or progression of abdominal aortic calcification. Participants will be assessed for up to 3 years to determine whether primary or secondary outcomes occur. Results: Between May 2019 and January 2021, all participating centers recruited 900 consecutive dialysis patients, including 786 undergoing hemodialysis (HD) and 114 undergoing peritoneal dialysis (PD). The mean age of the subjects was 60.4 ± 12.3 years. Males accounted for 57.7% of the total population. The mean dialysis vintage was 6.1 ± 6.0 years. The HD group was significantly older, had a longer dialysis vintage, and more comorbidities. Overall, the severity of vascular calcification was higher and the level of BMD was lower in the HD group than in the PD group. Conclusion: This nationwide, multicenter, prospective cohort study focused on chronic kidney disease-mineral and bone disorder and aimed to provide clinical evidence to establish optimal treatment guidelines for Asian dialysis patients. [ABSTRACT FROM AUTHOR]

The aim of the work described here was to determine the feasibility of using a novel biopsy needle detection technique that achieves high sensitivity and specificity in a trade-off of resolution, detectability and depth of imaging. The proposed needle detection method consists of a model-based image analysis, temporal needle projection and needle library matching: (i) Image analysis was formulated under the signal decomposition framework; (ii) temporal projection converted the time-resolved needle dynamics into a single image of the desired needle; and (iii) the enhanced needle structure was spatially refined by matching a long, straight linear object in the needle library. The efficacy was examined with respect to different needle visibility. Our method effectively eliminated confounding effects of the background tissue artifacts more robustly than conventional methods, thus improving needle visibility even with the low contrast between the needle and tissue. The improvement in needle structure further resulted in an improvement in estimation performance for the trajectory angle and tip position. Our three-step needle detection method can reliably detect needle position without the need for external devices, increasing the needle conspicuity and reducing motion sensitivity. [ABSTRACT FROM AUTHOR]

Highlights • An elementary precipitation method was used to synthesize ZnO QDs. • ZnO QDs guiding layer facilitate immobilization of uricase and showed high sensitivity, and reproducibility. • A three electrode based electrochemical biosensor was successfully fabricated for uric acid analysis. • Biosensor showed a wide linear range of detection 1–10 mM, covers the physiological range present in urine sample. Abstract Current trends in biosensors research include the application of nanomaterials to; provide a stable platform for immobilization and improving sensitivity. Quantum dots (QDs) are highly dispersed and extremely small (4–6 nm) particles that have been recognized to greatly increase the sensitivity by providing a larger surface area for binding of enzymes on the surface of the electrodes. Zinc oxide quantum dots (ZnO QDs) were synthesized through precipitation method and were characterized using TEM, UV–vis, and Raman spectroscopy to determine their properties. In this research work, we investigate the scope of ZnO QDs for the immobilization of uricase, an acidic enzyme having low isoelectric point, on the surface of nanostructured guiding layer for the detection of uric acid (UA). A three electrode based electrochemical biosensor was successfully fabricated using screen printing technique. The carbon electrode was modified with a thin film of ZnO QDs; the prepared thin film was utilized as working electrode. The ZnO QDs were subsequently functionalized with uricase to fabricate a selective uric acid sensor. The printed electrochemical sensor showed a linear response over a range of 1 mM–10 mM with a high sensitivity of 4.0 μA/mM cm−2. As a result, the procedures developed here are useful for the development of technologies accomplished of meeting the massive market demand of biosensors. [ABSTRACT FROM AUTHOR]

Polyethylene oxide (PEO) is a polymer hydrogel possessing ionic conductivity that varies with different percentage of absorbed water molecules and ions. This property makes it a good candidate to be used in humidity sensors’ active layers. The degree of crystallinity of PEO thin films decrease with increasing humidity that facilitates the ion conduction in the thin films, thus reducing the film impedance. In this research work, the humidity sensing properties of the thin films of semi-crystalline PEO have been investigated and the material is then modified to its amorphous dominant phase by heating the thin films beyond the melting point of the polymer. The slowly cooled resulting thin films had a waxy solid like appearance and showed an excellent response towards quantitative detection of relative humidity in the surrounding environment. The results show a roughly linear impedance versus relative humidity curve in the range of 0% RH to 90% RH with a very high maximum achieved sensitivity of ∼35 kΩ/%RH. The response and recovery times measured for the modified sensors were 2.8 s and 5.7 s respectively. The 30 day trial of stability readings showed a standard deviation of only 1%. The results prove thermally modified amorphous PEO thin films to be strong candidates for high end electronic relative humidity sensors. [ABSTRACT FROM AUTHOR]

Despite the clear association between low BMD and all-cause mortality in the general population, the association has not been validated in patients with nondialysis CKD. To investigate the association of low BMD with all-cause mortality in this population, a total of 2089 patients with nondialysis CKD at stages 1 to predialysis 5 were categorized into normal BMD (T-score ≥ −1.0), osteopenia (−2.5 < T-score < −1.0), and osteoporosis (T-score ≤ − 2.5) by the BMD at femoral neck. The study outcome was all-cause mortality. Kaplan–Meier curve depicted a significantly increased number of all-cause death events in the subjects with osteopenia or osteoporosis during the follow-up period compared with subjects with normal BMD. Cox regression models demonstrated that osteoporosis, but not osteopenia, was significantly associated with an increased risk of all-cause mortality (adjusted hazard ratio 2.963, 95% confidence interval 1.655 to 5.307). Smoothing curve fitting model visualized a clear inverse correlation between BMD T-score and the risk of all-cause mortality. Even after recategorizing the subjects by BMD T-scores at total hip or lumbar spine, the result was similar to the primary analyses. Subgroup analyses revealed that the association was not significantly modified by clinical contexts, such as age, gender, body mass index, estimated glomerular filtration rate, and albuminuria. In conclusion, low BMD is associated with an increased risk of all-cause mortality in patients with nondialysis CKD. This emphasizes that the routine measurement of BMD by DXA may confer an additional benefit beyond the prediction of fracture risk in this population. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate changes in health-related quality of life (HRQOL) in patients with chronic kidney disease (CKD) according to decline in kidney function. HRQOL was assessed using the Short Form-36 questionnaire composed of a physical component summary (PCS) and mental component summary (MCS). Rapid decline in kidney function was defined as a decline in the estimated glomerular filtration rate (eGFR) of > 3 mL/min/1.73 m2/year. Rapid deterioration of HRQOL was defined a change in the HRQOL value greater than the median. Among 970 patients, 360 (37.1%) were in the rapid kidney function decline group. In 720 patients who were 1:1 propensity score-matched, the baseline eGFR was not significantly different between the non-rapid and rapid kidney function decline groups. Compared with the baseline PCS score, the 5-year PCS score decreased in the non-rapid and rapid kidney function decline groups. The 5-year MCS score significantly decreased in the rapid kidney function decline group alone. Rapid decline in kidney function was significantly associated with rapid deterioration of the PCS (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.07–2.05; P = 0.018) and MCS (OR: 1.89; 95% CI 1.36–2.62; P < 0.001) scores. Rapid decline in kidney function was associated with rapid deterioration of HRQOL in patients with CKD. [ABSTRACT FROM AUTHOR]

Background/Aims: Whether the postobstructive natriuresis and diuresis is related with an altered regulation of sodium transporters in the kidney was examined. Methods: Male Sprague-Dawley rats underwent either bilateral (BUO) or unilateral obstruction (UUO) of the proximal ureters for 24 h. The expression of Na,K-ATPase, type-3 sodium-hydrogen exchanger (NHE3), type-1 bumetanide-sensitive sodium cotransporter (BSC1), and thiazide-sensitive sodium cotransporter (TSC) proteins was determined in the obstructed kidney by Western blot analysis and immunohistochemistry. Catalytic activity of Na,K-ATPase was also determined. Results: The expression of α1 and β1 subunit proteins and the catalytic activity of Na,K-ATPase were significantly decreased in the obstructed kidney in BUO. The expressions of NHE3, BSC1 and TSC proteins were also significantly decreased. Immunohistochemistry confirmed the downregulation of these sodium transporters in the obstructed kidney. In UUO, the expression of sodium transporters was similarly decreased in the obstructed kidney. Conclusion: The postobstructive natriuresis and diuresis may in part be accounted for by a reduced abundance of sodium transporters in the kidney. Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Proteinuria is typically quantified according to the spot urine protein–creatinine ratio (UPCR) and an association with cardiovascular events has not been thoroughly investigated in chronic kidney disease (CKD) patients. We investigated whether the severity of proteinuria assessed by spot UPCR is associated with an increased risk for cardiovascular outcomes in the CKD population, and whether the relationship is influenced by urine creatinine concentration. We analyzed 1746 patients enrolled as part of The KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). Multivariable Cox proportional hazard analysis was performed to evaluate models with proteinuria as a predictor of renal events and extended major adverse cardiovascular events (eMACEs). Risk for renal events was significantly associated with proteinuria across all eGFR and UPCR categories. By contrast, risk for eMACEs increased significantly with UPCR in patients with eGFR ≥ 60 mL/min/1.73 m2 (hazard ratio [HR] 2.109; 95% confidence interval [CI] 1.375–3.235; P = 0.001), but not in patients with eGFR < 60 mL/min/1.73 m2 (HR 1.086; 95% CI 0.910–1.296; P = 0.358). However, in those with the lower eGFR, risk for eMACEs increased significantly with UPCR in participants with urine creatinine concentration ≥ 95 mg/dL (HR 1.503; 95% CI 1.047–2.159; P = 0.027). In non-dialysis CKD patients, the prognostic value of UPCR for eMACEs is weakened in patients with reduced eGFR levels, for whom it has prognostic significance only in patients with high urine creatinine concentration. [ABSTRACT FROM AUTHOR]

The prognostic value of urinary angiotensinogen (UAGT) in patients with chronic kidney disease (CKD) has not been completely evaluated, although the association of UAGT with renal outcomes has been suggested in specific subsets of CKD. In the present study, to investigate the association of UAGT with renal outcomes in patients with non-dialysis CKD irrespective of the primary cause, a total of 1688 subjects from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) were prospectively analyzed. The subjects were divided into the quintile by UAGT to urine creatinine ratio (UAGT/Cr) level. The primary outcomes of interest were composite renal event, which included decline in kidney function and onset of end-stage renal disease during follow-up periods. The median follow-up duration was 6.257 years. Cox regression model analysis unveiled that the risk of composite renal event was significantly higher in the fifth quintile (adjusted hazard ratio 1.528, 95% confidence interval 1.156 to 2.021) compared to that of the first quartile. The association between high UAGT/Cr level and adverse renal outcome remained consistent in sensitivity analyses, including the analysis of the cause-specific hazard model. Subgroup analyses revealed that the association of UAGT level with renal outcomes is modified by certain clinical contexts, such as BMI and albuminuria. In conclusion, high UAGT level is associated with adverse renal outcomes in patients with non-dialysis CKD. Further studies are warranted to elaborate and expand the predictive role of UAGT as a biomarker for renal outcomes in CKD. [ABSTRACT FROM AUTHOR]

Renal fibrosis is a chronic pathological process that seriously endangers human health. However, the current therapeutic options for this disease are extremely limited. Previous studies have shown that signaling factors such as JAK2/STAT3, Smad3, and Myd88 play a regulatory role in renal fibrosis, and β-elemene is a plant-derived sesquiterpenoid organic compound that has been shown to have anti-inflammatory, anti-cancer, and immunomodulatory effects. In the present study, the anti-fibrotic effect of β-elemene was demonstrated by in vivo and in vitro experiments. It was shown that β-elemene inhibited the synthesis of extracellular matrix-related proteins in unilateral ureteral obstruction mice, and TGF-β stimulated rat interstitial fibroblast cells, including α-smooth muscle actin, vimentin, and connective tissue growth factor, etc. Further experiments showed that β-elemene reduced the expression levels of the above-mentioned fibrosis-related proteins by blocking the phosphorylation of JAK2/STAT3, Smad3, and the expression or up-regulation of MyD88. Notably, knockdown of MyD88 attenuated the phosphorylation levels of STAT3 and Smad3 in TGF-β stimulated NRK49F cell, which may be a novel molecular mechanism by which β-elemene affects renal interstitial fibrosis. In conclusion, this study elucidated the anti-interstitial fibrosis effect of β-elemene, which provides a new direction for future research and development of drugs related to chronic kidney disease. [ABSTRACT FROM AUTHOR]

In this paper, a tracking method based on sequential Bayesian inference is proposed. The proposed method focuses on solving both the problem of tracking under partial occlusions and the problem of non-rigid object tracking in real-time on a desktop personal computer (PC). The proposed method is mainly composed of two parts: (1) modeling the target object using elastic structure of local patches for robust performance; and (2) efficient hierarchical diffusion method to perform the tracking procedure in real-time. The elastic structure of local patches allows the proposed method to handle partial occlusions and non-rigid deformations through the relationship among neighboring patches. The proposed hierarchical diffusion method generates samples from the region where the posterior is concentrated to reduce computation time. The method is extensively tested on a number of challenging image sequences with occlusion and non-rigid deformation. The experimental results show the real-time capability and the robustness of the proposed method under various situations. [ABSTRACT FROM AUTHOR]

Background: The reactive oxygen species (ROS) and inflammation, a critical contributor to tissue damage, is well-known to be associated with various disease. The kidney is susceptible to hypoxia and vulnerable to ROS. Thus, the vicious cycle between oxidative stress and renal hypoxia critically contributes to the progression of chronic kidney disease and finally, end-stage renal disease. Thus, delivering therapeutic agents to the ROS-rich inflammation site and releasing the therapeutic agents is a feasible solution. Results: We developed a longer-circulating, inflammation-sensing, ROS-scavenging versatile nanoplatform by stably loading catalase-mimicking 1-dodecanethiol stabilized Mn3O4 (dMn3O4) nanoparticles inside ROS-sensitive nanomicelles (PTC), resulting in an ROS-sensitive nanozyme (PTC-M). Hydrophobic dMn3O4 nanoparticles were loaded inside PTC micelles to prevent premature release during circulation and act as a therapeutic agent by ROS-responsive release of loaded dMn3O4 once it reached the inflammation site. Conclusions: The findings of our study demonstrated the successful attenuation of inflammation and apoptosis in the IRI mice kidneys, suggesting that PTC-M nanozyme could possess promising potential in AKI therapy. This study paves the way for high-performance ROS depletion in treating various inflammation-related diseases. [ABSTRACT FROM AUTHOR]

Fabry disease (FD) is a rare X-linked lysosomal storage disorder that results from the deficient activity of the lysosomal enzyme α-galactosidase A (α-Gal A) enzyme. Kidney transplantation is an option for treating end-stage renal disease in patients with FD. However, only a few cases of kidney transplantation have been reported involving patients with FD and end-stage renal disease and cardiomyopathy after enzyme replacement therapy. A 53-year-old man who underwent peritoneal dialysis was referred to our department because his brother was diagnosed with FD. The diagnosis of FD was also confirmed in our patient on account of the reduced leukocyte α-Gal A enzyme activity and mutation in the α-galactosidase A gene (p.Arg301Gln). Though our patient had end-stage renal disease, he received enzyme replacement therapy with 1 mg/kg agalsidase-β every 2 weeks (Fabrazyme; Genzyme Co, Mass, USA) owing to markedly diffuse cardiac hypertrophy. Six years later, he underwent successful deceased-donor kidney transplantation. The post-transplantation course was uneventful, 4 months after transplantation. However, though he showed T-cell-mediated rejection on kidney biopsy, lamellar lysosomal inclusions were not present in vascular endothelial cells. After several months, a permanent pacemaker was inserted owing to a complete atrioventricular block; the patient died of sepsis and candidemia 1 year later. Deceased-donor kidney transplantation was successfully performed in an FD patient with sustained enzyme replacement therapy. However, owing to high cardiac morbidity and infection risks even after enzyme replacement therapy, close monitoring of these risks is essential for increasing patient survival after kidney transplantation. [ABSTRACT FROM AUTHOR]

The biodiesel synthesis intensification can be easily done with the help of microfluidic devices. In this paper, three novel designs are proposed for evaluating mixing performance required for biodiesel preparation. These designs are investigated numerically and then tested experimentally by fabrication of its chips. The current work is focused on the transesterification of sunflower oil with ethanol at room temperature conditions to elaborate on the application of our micromixer for biodiesel synthesis. The mixing of fluids is analyzed in the range of Reynolds number 0.5–100. The designs are proposed based on split and recombination and cantor fraction structure ideas. These designs are YCMSAR, YSMSAR, and YCSMSAR. All these designs are good for effective mixing. However, the YCSMSAR micromixer demonstrates better mixing index of 99.9% at Reynolds number, Re = 100. The effectiveness of our selected design is supported by various plots and contours simulated by COMSOL and by experimental images and supplementary video. [ABSTRACT FROM AUTHOR]

Background: Recently, we developed hydrophobically modified glycol chitosan (HGC) nanomicelles loaded with tacrolimus (TAC) (HGC-TAC) for the targeted renal delivery of TAC. Herein, we determined whether the administration of the HGC-TAC nanomicelles decreases kidney injury in a model of lupus nephritis. Lupus-prone female MRL/lpr mice were randomly assigned into three groups that received intravenous administration of either vehicle control, an equivalent dose of TAC, or HGC-TAC (0.5 mg/kg TAC) weekly for 8 weeks. Age-matched MRL/MpJ mice without Faslpr mutation were also treated with HGC vehicle and used as healthy controls. Results: Weekly intravenous treatment with HGC-TAC significantly reduced genetically attributable lupus activity in lupus nephritis-positive mice. In addition, HGC-TAC treatment mitigated renal dysfunction, proteinuria, and histological injury, including glomerular proliferative lesions and tubulointerstitial infiltration. Furthermore, HGC-TAC treatment reduced renal inflammation and inflammatory gene expression and ameliorated increased apoptosis and glomerular fibrosis. Moreover, HGC-TAC administration regulated renal injury via the TGF-β1/MAPK/NF-κB signaling pathway. These renoprotective effects of HGC-TAC treatment were more potent in lupus mice compared to those of TAC treatment alone. Conclusion: Our study indicates that weekly treatment with the HGC-TAC nanomicelles reduces kidney injury resulting from lupus nephritis by preventing inflammation, fibrosis, and apoptosis. This advantage of a new therapeutic modality using kidney-targeted HGC-TAC nanocarriers may improve drug adherence and provide treatment efficacy in lupus nephritis mice. [ABSTRACT FROM AUTHOR]

Background Urinary chloride is regulated by kidney transport channels, and high urinary chloride concentration in the distal tubules can trigger tubuloglomerular feedback. However, little attention has been paid to urinary chloride as a biomarker of clinical outcomes. Here, we studied the relationship between urinary chloride concentration and chronic kidney disease (CKD) progression. Methods We included 2086 participants with CKD from the KoreaN cohort study for Outcomes in patients With Chronic Kidney Disease. Patients were categorized into three groups, according to baseline urinary chloride concentration tertiles. The study endpoint was a composite of ≥50% decrease in estimated glomerular filtration rate from baseline values, or end-stage kidney disease. Results During a median follow-up period of 3.4 years (7452 person-years), 565 participants reached the primary endpoint. There was a higher rate of CKD progression events in the lowest and middle tertiles than in the highest tertile. Compared with the lowest tertile, the highest tertile was associated with 33% [95% confidence interval (CI) 0.49–0.90] lower risk for the primary outcome in a cause-specific hazard model after adjustment for confounding variables. In addition, for every 25 mEq/L increase in urinary chloride concentration, there was 11% (95% CI 0.83–0.96) lower risk for CKD progression. This association was consistent in a time-varying model. Urinary chloride concentration correlated well with tubule function and kidney injury markers, and its predictive performance for CKD progression was comparable to that of these markers. Conclusions In this hypothesis-generating study, low urinary chloride concentration was associated with a higher risk for CKD progression. [ABSTRACT FROM AUTHOR]

Background Diet is a modifiable factor of chronic kidney disease (CKD) progression. However, the effect of dietary salt intake on CKD progression remains unclear. Therefore, we analyzed the effect of dietary salt intake on renal outcome in Korean patients with CKD. Methods We measured 24-h urinary sodium (Na) excretion as a marker of dietary salt intake in the prospective, multi-center, longitudinal KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD). Data were analyzed from CKD patients at Stages G3a to G5 (n  = 1254). We investigated the association between dietary salt intake and CKD progression. Patients were divided into four quartiles of dietary salt intake, which was assessed using measured 24-h urinary Na excretion. The study endpoint was composite renal outcome, which was defined as either halving the estimated glomerular filtration rate or developing end-stage renal disease. Results During a median (interquartile range) follow-up of 4.3 (2.8–5.8) years, 480 (38.7%) patients developed the composite renal event. Compared with the reference group (Q2, urinary Na excretion: 104.2 ≤ Na excretion < 145.1 mEq/day), the highest quartile of measured 24-h urinary Na excretion was associated with risk of composite renal outcome [Q4, urinary Na excretion ≥192.9 mEq/day, hazard ratio 1.8 (95% confidence interval 1.12–2.88); P = 0.015] in a multivariable hazards model. Subgroup analyses showed that high-salt intake was particularly associated with a higher risk of composite renal outcome in women, in patients <60 years of age, in those with uncontrolled hypertension and in those with obesity. Conclusions High salt intake was associated with increased risk of progression in CKD. [ABSTRACT FROM AUTHOR]

Identification of individuals at risk of hypertension development based on socio-economic status have been inconclusive, due to variable definitions of low socio-economic status. We investigated whether educational status of individuals or their parents predicts prevalent hypertension in young adult population, by analyzing data of more than 37,000 non-institutionalized subjects from Korea National Health and Nutrition Examination Survey 2008 to 2017. Although low educational status of individual subjects was robustly associated with elevation of systolic blood pressure and increased prevalence of hypertension in general population, its impact on prevalent hypertension differed across age subgroups, and was remarkably attenuated in young adults. Parental educational status was significantly associated with prevalent hypertension in young adults, but not or only marginally in elderly population. Low parental educational status was also associated with high sodium intake in young adults, irrespective of subject's own educational status. These collectively indicate that parental educational status, rather than individual's own educational status, better and independently predicts prevalent hypertension in young adults, and that young adults with low parental educational status are prone to intake more sodium, possibly contributing to the increased risk of hypertension development. We expect that our findings could help define young individuals at risk of high sodium intake and hypertension. [ABSTRACT FROM AUTHOR]

Few studies have investigated the incidence of cardiovascular disease (CVD) in the Asian chronic kidney disease (CKD) population. This study assessed the incidence of CVD, death, and a composite outcome of CVD and death in a prospective Korean predialysis CKD cohort. From a total of 2179 patients, incidence rates were analyzed, and competing risk analyses were conducted according to CKD stage. Additionally, incidence was compared to the general population. During a median 4.1 years of follow-up, the incidence of CVD, all-cause death, and the composite outcome was 17.2, 9.6, and 24.5 per 1000 person-years, respectively. These values were higher in diabetic vs. non-diabetic subjects (P < 0.001). For all outcomes, incidence rates increased with increasing CKD stage (CVD, P = 0.001; death, P < 0.001; and composite, P < 0.001). Additionally, CKD stage G4 [hazard ratio (HR) 2.8, P = 0.008] and G5 (HR 5.0, P < 0.001) were significant risk factors for the composite outcome compared to stage G1 after adjustment. Compared to the general population, the total cohort population (stages G1–G5) showed significantly higher risk of CVD (HR 2.4, P < 0.001) and the composite outcome (HR 1.7, P < 0.001). The results clearly demonstrate that CKD is a risk factor for CVD in an Asian population. [ABSTRACT FROM AUTHOR]

Introduction: In patients with chronic kidney disease (CKD), studies investigating the association between smoking and deterioration of kidney function are scarce.Aims and Methods: We analyzed data for 1,951 patients with an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2 enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) from 2011 to 2016. Patients were categorized by smoking load. Primary outcome was a composite of a ≥50% reduction in eGFR, initiation of dialysis, or kidney transplantation.Results: There were 967 never-smokers and 369, 276, and 339 smokers who smoked <15, 15 to 29, ≥30 pack-years, respectively. During a mean follow-up of 3.0 years, the incidence rates (95% confidence interval [CI]) of the primary outcome were 54.3 (46.4-63.5), 46.9 (35.9-61.4), 69.2 (52.9-90.6), and 76.3 (60.7-96.0) events per 1,000 person-yr in never-, <15, 15 to 29, and ≥30 pack-year smokers. In cause-specific hazard model after adjustment of confounding factors, smokers were associated with 1.09 (0.73-1.63), 1.48 (1.00-2.18), and 1.94 (1.35-2.77) fold increased risk (95% CI) of primary outcome in <15, 15-29, and ≥30 pack-year smokers compared with never-smokers. The association of longer smoking duration with higher risk of CKD progression was evident particularly in patients with eGFR < 45 mL/min/1.73 m2 and proteinuria ≥ 1.0 g/g. In contrast, the risk of adverse kidney outcome decreased with longer smoking-free periods among former-smokers.Conclusions: These findings suggest potentially harmful effects of the degree of exposure to smoking on the progression of CKD.Implications: Among patients with CKD, there has been lack of studies on the association between smoking and CKD progression and studies to date have yielded conflicting results. In this prospective cohort study involving Korean CKD patients, smoking was associated with significantly higher risk of worsening kidney function. Furthermore, the risk of adverse kidney outcome was incrementally higher as smoking pack-years were higher. As the duration of smoking cessation increased, the hazard ratios for adverse kidney outcome were attenuated, suggesting that quitting smoking may be a modifiable factor to delay CKD progression. [ABSTRACT FROM AUTHOR]

The number of chronic renal disease patients has shown a significant increase in recent decades over the globe. Hemodialysis is the most commonly used treatment for renal replacement therapy (RRT) and dominates the global dialysis market. As one of the most water-consuming treatments in medical procedures, hemodialysis has room for improvement in reducing wastewater effluent. In this study, we investigated the technological feasibility of introducing the forward osmosis (FO) process for spent dialysate reuse. A 30 LMH of average water flux has been achieved using a commercial TFC membrane with high water permeability and salt removal. The water flux increased up to 23% with increasing flowrate from 100 mL/min to 500 mL/min. During 1 h spent dialysate treatment, the active layer facing feed solution (AL-FS) mode showed relatively higher flux stability with a 4–6 LMH of water flux reduction while the water flux decreased significantly at the active layer facing draw solution (AL-DS) mode with a 10–12 LMH reduction. In the pressure-assisted forward osmosis (PAFO) condition, high reverse salt flux was observed due to membrane deformation. During the membrane filtration process, scaling occurred due to the influence of polyvalent ions remaining on the membrane surface. Membrane fouling exacerbated the flux and was mainly caused by organic substances such as urea and creatinine. The results of this experiment provide an important basis for future research as a preliminary experiment for the introduction of the FO technique to hemodialysis. [ABSTRACT FROM AUTHOR]

Proteinuria and hyperphosphatemia are risk factors for cardiovascular disease in patients with chronic kidney disease (CKD). Although the interaction between proteinuria and the serum phosphate level is well established, the mechanistic link between the two, particularly the extent to which this interaction is mediated by phosphate-regulating factors, remains poorly understood. In this study, we examined the association between proteinuria and the serum phosphate level, as well as potential mediators, including circulating fibroblast growth factor (FGF23)/klotho, the 24-h urinary phosphate excretion rate to glomerular filtration rate ratio (EP/GFR), and the 24-h tubular phosphate reabsorption rate to GFR ratio (TRP/GFR). The analyses were performed with data from 1793 patients in whom 24-h urine protein and phosphate, serum phosphate, FGF23, and klotho levels were measured simultaneously, obtained from the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD). Multivariable linear regression and mediation analyses were performed. Total, direct, and indirect effects were also estimated. Patients with high serum phosphate levels were found to be more likely to exhibit greater proteinuria, higher FGF23 levels, and lower klotho levels. The 24-h EP/GFR increased and the 24-h TRP/GFR decreased with increasing proteinuria and CKD progression. Simple mediation analyses showed that 15.4% and 67.9% of the relationship between proteinuria and the serum phosphate level were mediated by the FGF23/klotho ratio and 24-h EP/GFR, respectively. Together, these two factors accounted for 73.1% of the relationship between serum markers. These findings suggest that proteinuria increases the 24-h EP/GFR via the FGF23/klotho axis as a compensatory mechanism for the increased phosphate burden well before the reduction in renal function is first seen. [ABSTRACT FROM AUTHOR]

High serum adiponectin is noted in several conditions of chronic kidney disease (CKD) and is a predictor for end stage renal disease. However, the relationship between adiponectin level and renal disease progression is not well established. This study aimed to determine the relationship between serum adiponectin levels and CKD progression. This prospective longitudinal study included 2238 patients from the Korean Cohort Study for Outcomes in Patients with Chronic Kidney Disease. Patients were divided into quartiles according to their serum adiponectin level. Composite renal outcome was defined as one or more of the following: initiation of dialysis or transplantation, a two-fold increase in baseline serum creatinine levels, or a 50% decline in the estimated glomerular filtration rate (eGFR) during the follow-up period. A cox proportional hazard ratio model was applied to analyze the relationship between composite renal outcome and serum adiponectin levels. Serum adiponectin level was inversely associated with eGFR (p < 0.001) and positively correlated with urine albumin-creatinine ratio. The highest quartile of serum adiponectin was associated with an increased risk of adverse renal outomes (HR, 1.39; 95%CI, 1.05-1.84; p=0.021). On time-dependent receiver operating characteristic curve analysis, predictive ability of adiponectin for renal outcomes disappeared after adjusting for eGFR. Therefore, serum adiponectin may be a biomarker of renal dysfunction rather than a true risk factor in CKD progression. [ABSTRACT FROM AUTHOR]

The impact of obesity on health-related quality of life (HRQoL) in chronic kidney disease (CKD) population has not been elucidated, despite the impairment of HRQoL in the obese among general population. We hypothesized that the impact of obesity on HRQoL might be confounded by impaired renal function in CKD population, and that CKD would attenuate the impact of obesity on HRQoL. To compare the impact of obesity on HRQoL according to kidney function, 17,001 subjects from Korea National Health and Nutrition Examination Survey (2008–2011) were categorized by estimated glomerular filtration rate (eGFR), as follows: group 1, eGFR ≥ 90 mL/min/1.73 m2; group 2, eGFR of 60–89 mL/min/1.73 m2; group 3, eGFR < 60 mL/min/1.73 m2. The association between obesity parameters (body mass index, waist circumference and, truncal fat mass) and HRQoL parameters (EQ-5D index and EQ-VAS) were cross-sectionally analyzed. Despite robust correlations between obesity parameters and low EQ-5D index or EQ-VAS in general population, no significant association was observed in group 3 population. Impact of obesity on HRQoL in CKD population was only limitedly observed in the mobility domain of EQ-5D, as mobility limitation was associated with increased body mass index or waist circumference regardless of kidney function. Therefore, the impact of obesity on HRQoL seems significantly attenuated in CKD population, suggesting that the risk of obesity should not be over-estimated in patients with CKD, especially with respect to HRQoL. [ABSTRACT FROM AUTHOR]

Background: Darbepoetin-alfa is an erythropoiesis-stimulating agent (ESA) with a long elimination half-life that achieves better hemoglobin (Hb) stability than short-acting ESAs. Objective: We aimed to evaluate the efficacy and safety of intravenous CKD-11101 (a biosimilar of darbepoetin-alfa) compared with those of darbepoetin-alfa in hemodialysis patients. Methods: The study was performed in 24 centers in Korea between June 2015 and June 2017. The study subjects were randomized in a double-blind manner. The follow-up duration was 24 weeks, which consisted of 20 weeks of maintenance and 4 weeks of evaluation period. All patients underwent a stabilization period to achieve a target baseline Hb of 10–12 g/dL before randomization. Following randomization, patients received darbepoetin-alfa or CKD-11101 weekly or biweekly. Results: A total of 403 patients were randomized into two groups, and a total of 325 patients (80.6%) completed the investigation. The differences between the two groups in terms of change in the average Hb level from baseline to evaluation were not significant. The average administered dose of ESA was similar between the groups. There was no difference in the proportion of patients who maintained the target Hb during the evaluation period [60.4% vs. 66.2% in the CKD-11101 and darbepoetin-alfa groups, respectively (p = 0.3038)]. In addition, the safety analysis, consisting of adverse events and adverse drug reactions, showed comparable results between the two groups. Conclusion: The changes in the level of Hb, dose of erythropoietin, and achievement rate of the target Hb during the study period were comparable between the groups. CKD-11101 has an equivalent efficacy and safety compared with darbepoetin-alfa in patients undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

The impact of health-related quality of life (HRQOL) on outcomes remains unclear in chronic kidney disease (CKD) patients despite its importance in socioeconomic aspects and individual health. We aim to identify the relationship between HRQOL and progression of CKD in pre-dialysis patients. A total 1622 patients with CKD were analyzed in the KoreaN cohort Study for Outcomes in patients With Chronic Kidney Disease, a prospective cohort study. CKD progression was defined as one or more of the following: initiation of dialysis or transplantation, a two-fold increase in baseline serum creatinine levels, or a 50% decline in the estimated glomerular filtration rate during the follow-up period. The group with CKD progression had lower scores of HRQOL than the group without CKD progression. A fully adjusted Cox proportional hazard ratio model showed that each low baseline physical and mental component summary score was associated with a higher risk of CKD progression. In Kaplan-Meier survival analysis using propensity score matched data, only low physical component summary scores showed statistical significance with CKD progression. Our study highlights low physical component summary score for an important prognostic factor of CKD progression. Risk-modification interventions for high-risk patients may provide benefits to individuals. [ABSTRACT FROM AUTHOR]

We analyzed data from the Korean National Health Insurance Service (NHIS) to investigate whether smoking increases the risk of end-stage kidney disease (ESKD). This retrospective nationwide population-based cohort study included the data of 23,232,091 participants who underwent at least one health examination between 2009 and 2012. Smoking status was recorded at baseline. The incidence of ESKD was identified via ICD-10 codes and special medical aid codes from the Korean National Health Insurance Service database till December 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between smoking and ESKD incidence. Overall, 24.6% of participants were current smokers; 13.5% and 61.9%, were ex- and non-smokers, respectively. Overall, 45,143 cases of ESKD developed during the follow-up period. Current smokers (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.35–1.43) and ex-smokers (HR, 1.09; 95% CI, 1.06–1.12) demonstrated a significant increase in the adjusted risk of ESKD compared to non-smokers. The risk of ESKD was directly proportional to the smoking duration, number of cigarettes smoked daily, and pack-years. In conclusion, smoking is associated with a greater risk of ESKD in the general Korean population; the risk increases with an increase in the smoking duration, number of cigarettes smoked daily, and pack-years. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is known to be associated with metabolic dysregulation and incident cardiovascular diseases. However, its association with end-stage renal disease (ESRD) has not been clarified. This study aimed to evaluate longitudinally whether OSA is an independent risk factor for ESRD. Methods: This retrospective nationwide population-based cohort study included data on 67,359 patients with OSA and 336,795 age-, sex- and years of the enrollment-matched controls without OSA obtained from the Korean National Health Insurance Service database from 2009 to 2014. The study population was followed up from baseline to the date of ESRD diagnosis or until 2016. A Cox proportional-hazards model with multivariable adjustment was used to evaluate the association between OSA and incident ESRD. Results: A significantly higher incident ESRD risk (adjusted hazard ratio: 1.29, 95% confidence interval 1.02–1.62) was observed for patients older than 40 years with OSA than for matched controls, when adjusted for age, sex, income status, smoking, alcohol consumption, body mass index, diabetes, hypertension, dyslipidemia, estimated glomerular filtration rate, and proteinuria. The OSA group remained predictive of higher risk of ESRD incidence in subgroups of age ≥ 65 years, female sex, hypertension, dyslipidemia, proteinuria, and chronic kidney disease. Conclusion: OSA was associated with a higher risk of incident ESRD. Understanding the association between OSA and ESRD might provide further insights to establish national health care policy. [ABSTRACT FROM AUTHOR]

Background: Urine osmolality indicates the ability of the kidney to concentrate the urine and reflects the antidiuretic action of vasopressin. However, results about the association between urine osmolality and adverse renal outcomes in chronic kidney disease (CKD) are conflicting. We investigated the association between urine osmolality and adverse renal outcomes in a nationwide prospective CKD cohort. Methods: A total of 1,999 CKD patients were categorized into 3 groups according to their urine osmolality tertiles. Primary outcome was a composite of 50% decline in the estimated glomerular filtration rate (eGFR), initiation of dialysis, or kidney transplantation. Results: During a mean follow-up of 35.2 ± 19.0 months, primary outcome occurred in 432 (21.6%) patients; 240 (36.4%), 162 (24.3%), and 30 (4.5%) in the lowest, middle, and highest tertiles, respectively. Low urine osmolality was independently associated with a greater risk of CKD progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.12–2.59). This association was particularly evident in patients with CKD stages 3–4 (per 10 mosm/kg decrease; HR, 1.02; 95% CI, 1.00–1.03). Adding urine osmolality to a base model with conventional factors significantly increased the ability to predict CKD progression (C-statistics, 0.86; integrated discrimination improvement [IDI], 0.021; both p < 0.001). However, adding both urine osmolality and eGFR did not further improve the predictive ability compared with the addition of eGFR only (C-statistics, p = 0.29; IDI, p = 0.09). Conclusions: Low urine osmolality was an independent risk factor for adverse renal outcomes in CKD patients, but its predictive ability did not surpass eGFR. Thus, kidney function should be considered while interpreting the clinical significance of urine osmolality. [ABSTRACT FROM AUTHOR]

• A piezocapacitive biodegradable pressure sensor has been fabricated. • Device targets low pressure measurements in tactile range of 0 < P < 5 kPa. • Nanofibrous PLGA-PCL membrane has been used as elastomeric dielectric. • It was used for wrist pulse monitoring and pressure mapping array applications. • 7 days of degradation caused a 19.5% decrease in sensitivity in low pressure range. High performance biodegradable electronic devices are becoming popular due to their enormous applications as biomedical implants or short term communication devices. They are biocompatible and eco-friendly. For example wearable or implantable biodegradable pressure sensors are very useful for cardiovascular or blood flow monitoring. But unfortunately very few previous researches have focused on developing biodegradable pressure sensors. Here we propose a composite of Polylactic-co-glycolic acid (PLGA) and Polycaprolactone (PCL) for biodegradable piezo-capacitive pressure sensor fabrication for low pressure measurement in tactile ranges of (0 < P < 5 kPa). An electrospun PLGA-PCL composite membrane has been used as elastomeric dielectric sandwiched between two biodegradable iron-zinc (Fe-Zn) bilayer electrodes, deposited on degradable Polyvinyl alcohol (PVA) substrate using electron beam deposition, and encapsulated in PLGA thin films for device fabrication. PLGA-PCL nanofibrous dielectric membrane is highly compressible and porous having tunable mechanical as well as dielectric properties and has been reported first ever for biodegradable pressure sensor application. The sensitivity of the sensor was found to be 0.863 ± 0.025 kPa−1 in the low pressure region (0 < P ≤ 1.86 kPa) which is quite high as compared to previous literature on biodegradable sensors so far while it adapted to a value of 0.062 ± 0.005 kPa−1 for high pressure region (1.86 kPa < P ≤ 4.6 kPa). The lowest detected value was 1.24 Pa (at 10mgf). Sensor showed good average response and recovery times of 251 ms and 170 ms respectively. In vitro degradation studies of the sensor were performed in PBS solution and sensor lost 60% of its initial weight during first two weeks of degradation and continued to degrade even after that. After one week of incubation sensor showed a 19.5% decrease in low pressure measurement range while there was no significant difference in upper detection range. It has been used to measure the arterial pulse wave on wrist and a 4 × 4 pressure sensor array was made to demonstrate its use in mapping different pressure points. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of CKD-11101 (biosimilar darbepoetin-alfa, Chong Kun Dang Pharm.) compared with NESP® in treatment of anaemia in patients with chronic kidney disease not on dialysis.Clinical Trial Registration: NCT03431623.Method: In this multi-centre, randomized, double-blind study, patients were treated with CKD-11101 and NESP. The efficacy evaluation period (EEP) was 24 weeks, during which patients were treated every 2 weeks. All patients who completed the EEP were treated with CKD-11101 every 2 weeks for the first 4 weeks and every 4 weeks for the safety evaluation period (SEP), which was from 24 weeks to 52 weeks. The primary efficacy endpoint was the change in mean haemoglobin (Hb) level from baseline to end of EEP and mean dose needed to achieve the target Hb.Results: The mean Hb level was increased in both groups during the EEP (both p < 0.001). The difference in mean Hb level change between the two groups was 0.01 g/dL (95% CI = -0.213-0.242), indicating that CKD-11101 was equivalent to NESP. The difference in mean administration dose between groups was -1.40 mcg (95% CI = -6.859-4.059) included in the equivalent range. The incidence of AEs and ADRs was not different between the two groups, and the frequency of ADRs was favourable in both groups (1.2% in CKD-11101 vs 7.7% in the NESP to CKD-11101 conversion group).Conclusion: CKD-11101 has an equivalent therapeutic effect as NESP in chronic kidney disease patients with renal anaemia. CKD-11101 can be safely used for long-term treatment and in patients converted from NESP. [ABSTRACT FROM AUTHOR]

A colorimetric portable setup was developed for remote UA measurements using a smartphone-based application to demonstrate its use in point-of-care testing. Quantitative and affordable point-of-care health diagnostics is a rapidly evolving field using nanostructured materials for the detection of various disease biomarkers. The detection of uric acid is of great importance to identify many health syndromes and to avoid relevant complications. Herein, a selective, sensitive, and quantitative detection of uric acid on a cellulose fiber strip using citrate-capped platinum nanoparticles (PtNPs) as a nanozyme is reported for the first time. A reduction method was followed to synthesize the PtNPs (8–10 nm), which were characterized using UV-vis spectroscopy, XRD, and TEM to determine their properties. Morphological characterization of the cellulose substrate was performed using FESEM. A strip was developed having a circular shaped head of 8 mm diameter, which was pretreated with PVA, TMB + H2O2, and PtNPs, respectively. In the presence of PtNPs (enzyme catalytic activity), TMB acted as a hydrogen donor to reduce H2O2, giving a bluish-green color on the substrate. The developed method provided a wide linear response from 0 mM to 8 mM for uric acid samples, with the results indicating the downregulating activity of the PtNPs. A calculated LOD of 4.2 ± 5 μM was achieved and the results showed a linear response till 7 mM in terms of the color observation. In conclusion, the developed sensing system could be potentially applicable for the quantitative detection of uric acid in the physiological range in urine samples. [ABSTRACT FROM AUTHOR]