Assessment of GFR by four methods in adults in Ashanti, Ghana: the need for an eGFR equation for lean African populations

Background. Equations for estimating glomerular filtration rate (GFR) have not been validated in Sub-Saharan African populations, and data on GFR are few. Methods. GFR by creatinine clearance (Ccr) using 24-hour urine collections and estimated GFR (eGFR) using the four-variable Modification of Diet in Renal Disease (MDRD-4)[creatinine calibrated to isotope dilution mass spectrometry (IDMS) standard], Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft–Gault equations were obtained in Ghanaians aged 40–75. The population comprised 1013 inhabitants in 12 villages; 944 provided a serum creatinine and two 24-hour urines. The mean weight was 54.4 kg; mean body mass index was 21.1 kg/m2. Results. Mean GFR by Ccr was 84.1 ml/min/1.73m2; 86.8% of participants had a GFR of 60 ml/min/1.73m2. Mean MDRD-4 eGFR was 102.3 ml/min/1.73m2 (difference vs. Ccr, 18.2: 95% CI: 16.8–19.5); when the factor for black race was omitted, the value (mean 84.6 ml/min/1.73m2) was close to Ccr. Mean CKD-EPI eGFR was 103.1 ml/min/1.73m2, and 89.4 ml/min/1.73m2 when the factor for race was omitted. The Cockcroft–Gault equation underestimated GFR compared with Ccr by 9.4 ml/min/1.73m2 (CI: 8.3–10.6); particularly in older age groups. GFR by Ccr, and eGFR by MDRD-4, CKD-EPI and Cockcroft–Gault showed falls with age: MDRD-4 5.5, Ccr 7.7, CKD-EPI 8.8 and Cockcroft–Gault 11.0 ml/min/1.73m2/10 years. The percentage of individuals identified with CKD stages 3–5 depended on the method used: MDRD-4 1.6% (7.2 % without factor for black race; CKD-EPI 1.7% (4.7% without factor for black race), Ccr 13.2% and Cockcroft–Gault 21.0%. Conclusions. Mean eGFR by both MDRD-4 and CKD-EPI was considerably higher than GFR by Ccr and Cockcroft–Gault, a difference that may be attributable to leanness. MDRD-4 appeared to underestimate the fall in GFR with age compared with the three other measurements; the fall with CKD-EPI without the adjustment for race was the closest to that of Ccr. An equation tailored specifically to the needs of the lean populations of Africa is urgently needed. For the present, the CKD-EPI equation without the adjustment for black race appears to be the most useful

Effects of Variable Oceanographic Conditions on Forage Fish Lipid Content and Fatty Acid Composition in the Northern California Current

Lipids and fatty acids (FA) were investigated in 4 species of forage fish: northern anchovy Engraulis mordax, Pacific sardine Sardinops sagax, Pacific herring Clupea pallasi, and whitebait smelt Allosmerus elongatus, for their ability to serve as biological indicators of ocean conditions in the California Current large marine ecosystem (CCLME). Samples were collected during the oceanographically contrasting years of 2005 and 2006. Upwelling was severely curtailed in the spring and early summer of 2005, leading to delayed biological productivity, whereas upwelling was relatively normal in spring 2006. Principal components analysis described 78% of the variance within the lipid and FA dataset using the first 2 principal components. We found significant intra- and interspecific, interannual, and seasonal differences in lipid and FA profiles using univariate and permutation- based multivariate analysis of variance. Indicator species analysis showed distinct lipid and FA properties associated with each fish species. Using the ratio of docosahexaenoic acid (C22:6n-3) to eicosapentaeonic acid (C20:5n-3), we detected a transition from a diet composed primarily of dinoflagellate origin in early 2005 to a diet resulting from diatom-based productivity by late summer 2006. This shift was due to interannual differences in primary production, which was confirmed through phytoplankton sampling. Our study demonstrates that lipid and FA biomarkers in the forage fish community can provide information on ocean conditions and productivity that affect food web structure in the CCLME

Red Cells Genetically Deficient in Carbonic Anhydrase II Have Elevated Levels of a Carbonic Anhydrase Indistinguishable from Muscle CA III a

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71425/1/j.1749-6632.1984.tb12351.x.pd

Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial:a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease

Abstract Background Falls are a common complication of Parkinson’s disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson’s disease. Methods This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson’s disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson’s motor and non-motor symptoms, quality of life and cost-effectiveness. Discussion This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson’s disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. Trial registration REC reference: 19/SW/0043. EudraCT: 2018–003219-23. ISCRTN: 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 Protocol at time of publication Version 7.0, 20th January 2021

Gel transitions in colloidal suspensions

The idealized mode coupling theory (MCT) is applied to colloidal systems interacting via short-range attractive interactions of Yukawa form. At low temperatures MCT predicts a slowing down of the local dynamics and ergodicity breaking transitions. The nonergodicity transitions share many features with the colloidal gel transition, and are proposed to be the source of gelation in colloidal systems. Previous calculations of the phase diagram are complemented with additional data for shorter ranges of the attractive interaction, showing that the path of the nonergodicity transition line is then unimpeded by the gas-liquid critical curve at low temperatures. Particular attention is given to the critical nonergodicity parameters, motivated by recent experimental measurements. An asymptotic model is developed, valid for dilute systems of spheres interacting via strong short-range attractions, and is shown to capture all aspects of the low temperature MCT nonergodicity transitions.Comment: 12 pages, LaTeX, 5 eps figures, uses ioplppt.sty, to appear in J. Phys.: Condens. Matte

Clinical Management of Hyperkalemia

© 2020 Mayo Foundation for Medical Education and Research Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K+ monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K+-binding agents. Monitoring serum K+ should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K+ binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K+ binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K+-binding agents requires further study to establish whether stringent dietary K+ restrictions are needed in patients receiving K+-binder therapy. Individualized monitoring of serum K+ among patients with an increased risk of hyperkalemia and the use of newer K+-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia

Abundance and local - scale processes contribute to multi-phyla gradients in global marine diversity

Among themost enduring ecological challenges is an integrated theory explaining the latitudinal biodiversity gradient, including discrepancies observed at different spatial scales. Analysis of Reef Life Survey data for 4127 marine species at 2406 coral and rocky sites worldwide confirms that the total ecoregion richness peaks in low latitudes, near +15°N and −15°S. However, although richness at survey sites ismaximal near the equator for vertebrates, it peaks at high latitudes for large mobile invertebrates. Site richness for different groups is dependent on abundance, which is in turn correlated with temperature for fishes and nutrients for macroinvertebrates. We suggest that temperature-mediated fish predation and herbivory have on strained mobile macroinvertebrate diversity at the site scale across the tropics. Conversely, at the ecoregion scale, richness responds positively to coral reef area, highlighting potentially huge global biodiversity losses with coral decline. Improved conservation outcomes require management frameworks, informed by hierarchical monitoring, that cover differing site- and regional-scale processes across diverse taxa, including attention to invertebrate species, which appear disproportionately threatened by warming seas

Freshwater umbrella - the effects of nitrogen deposition & climate change on freshwaters in the UK

In upland areas of the UK located away from direct human disturbance through agriculture, industrial activities and urban pollution, atmospheric pollution poses one of the major threats to the chemical and biological quality of lakes and streams. One of the most important groups of pollutants is nitrogen (N) compounds, including oxidised forms of N called NOx, generated mainly by fossil fuel combustion especially in motor vehicles, and reduced forms of N (ammonia gas or dissolved ammonium compounds) generated mainly from agricultural activities and livestock. These nitrogen compounds may dissolve in rain or soilwater to form acids, or may be taken up as nutrients by plants and soil microbes in upland catchments, and then subsequently released in acid form associated with nitrate leaching at a later date. It is well established that nitrate leaching contributes to acidification of upland waters, with damage to aquatic ecosystems including plants, invertebrates and fish. However it has recently been suggested that nitrate leaching may also be associated with nutrient enrichment of upland waters that contain biological communities adapted to very low nutrient levels

Hysteresis and hierarchies: dynamics of disorder-driven first-order phase transformations

We use the zero-temperature random-field Ising model to study hysteretic behavior at first-order phase transitions. Sweeping the external field through zero, the model exhibits hysteresis, the return-point memory effect, and avalanche fluctuations. There is a critical value of disorder at which a jump in the magnetization (corresponding to an infinite avalanche) first occurs. We study the universal behavior at this critical point using mean-field theory, and also present preliminary results of numerical simulations in three dimensions.Comment: 12 pages plus 2 appended figures, plain TeX, CU-MSC-747