Preface : “Practical Research on Gamification in Education (2)”

<p>(A) Areas under the curves (AUC) of receiver operating characteristics (ROC) in 746 patients for pentosidine in relation to all-cause mortality.(B) Areas under the curves (AUC) of receiver operating characteristics (ROC) in 746 patients for pentosidine in relation to CVD-mortality.</p

Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease

<div><p>Background</p><p>Cardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated glomerular filtration rate (GFR), CVD, PEW, and inflammation in individuals with normal to severely reduced GFR.</p><p>Methods</p><p>In 404 individuals with GFR category G1 (n = 31; GFR >90mL/min/1.73 m²), G2 (n = 46), G3 (n = 33), G4 (n = 49) and G5 (n = 245; GFR<15mL/min/1.73 m²), pulmonary function was assessed by spirometry. Obstructive (OLD) and restrictive (RLD) lung dysfunction was defined based on forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁) and peak expiratory flow (PEF), expressed as percentages of predicted values (þV₁, %FVC and %PEF, respectively). PEW was evaluated by subjective global assessment, handgrip strength (HGS) and lean body mass index (LBMI), and inflammation by interleukin-6 and high sensitivity C-reactive protein.</p><p>Results</p><p>RLD (defined as FEV₁/FVC ≥ 0.70 and %FVC<80) associated with GFR and was present in 36% of G5 and 14% of G1-4 individuals. OLD (FEV₁/FVC<0.70) was less common with similar prevalence among G1-4 (9%) and G5 (11%) individuals. Notably, 64% of those with concomitant presence of PEW, inflammation and clinical signs of CVD had RLD while 79% of those lacking these complications had normal lung function. In multivariate logistic regression analysis, RLD associated with CVD, PEW and inflammation, after adjusting for Framingham’s CVD risk score, serum albumin, and GFR category.</p><p>Conclusions</p><p>RLD is a common complication in patients with advanced CKD, especially in those with concomitant presence of CVD, inflammation and PEW. RLD appears to be an integral albeit scarcely explored consequence of pulmonary-renal interactions in CKD patients.</p></div

Prevalence of normal lung function, OLD and RLD in 404 individuals according to GFR categories 1–5.

<p>Chi square = 29.9, p<0.001. Abbreviations: OLD; obstructive lung disorder FEV1/FVC <0.70, RLD; restrictive lung disorder, FEV1/FVC ≥0.70 and %FVC <80. G-1 through G-5 are GFR categories: Normal (G1; n = 31; GFR >90mL/min/1.73 m2) or only mildly decreased (G2; n = 46) GFR, significant reductions of GFR, G3 (n = 33) and G4 (n = 49), and patients with kidney failure, G5 (n = 245; GFR<15mL/min/1.73 m2).</p

Multivariate logistic regression analysis of factors associated with obstructive (OLD) and restrictive (RLD) lung dysfunction in 404 individuals with GFR categories G1-5.

<p>Multivariate logistic regression analysis of factors associated with obstructive (OLD) and restrictive (RLD) lung dysfunction in 404 individuals with GFR categories G1-5.</p

The all-cause mortality risk for death occurring within 60 months based on imputed data in the combined cohort of 746 individuals, adjusted for all confounders, and expressed as relative risk ratio (95% confidence interval, CI).

<p>The all-cause mortality risk for death occurring within 60 months based on imputed data in the combined cohort of 746 individuals, adjusted for all confounders, and expressed as relative risk ratio (95% confidence interval, CI).</p

Baseline characteristics and biochemical parameters in all individuals participating in the study.

<p>Baseline characteristics and biochemical parameters in all individuals participating in the study.</p

The cardiovascular mortality risk for death occurring within 60 months based on imputed data in the combined cohort of 746 individuals, adjusted for all confounders, and expressed as relative risk ratio (95% confidence interval, CI).

<p>The cardiovascular mortality risk for death occurring within 60 months based on imputed data in the combined cohort of 746 individuals, adjusted for all confounders, and expressed as relative risk ratio (95% confidence interval, CI).</p

Predictors of one standard deviation (1-SD) higher plasma pentosidine concentration according to the imputed multivariate linear regression analysis in 746 patients.

<p>Predictors of one standard deviation (1-SD) higher plasma pentosidine concentration according to the imputed multivariate linear regression analysis in 746 patients.</p

Amino acid levels during summer and winter in 15 sub-adult free-ranging bears and 39 healthy subjects (28 males) with age 68 years (range 38–80 years).

<p>Median and range, NS; not significant, ^c winter vs summer.</p><p>BCAA; branched chain amino acids; EAA; essential amino acids; NEAA; non-essential amino acids.</p><p>Differences between healthy subjects versus summer levels of 15 sub-adult bears are denoted with ^ap<0.05, ^bp<0.001.</p

A positive correlation was observed between changes (Δ) in fructose and uric acid from winter to summer.

<p>This suggest that higher uric acid levels observed during the active summer period is in part dependent on increased fructose intake via fruits and berries.</p