Measured sodium excretion is associated with cardiovascular outcomes in non-dialysis CKD patients: results from the KNOW-CKD study

BackgroundThere are insufficient studies on the effect of dietary salt intake on cardiovascular (CV) outcomes in chronic kidney disease (CKD) patients, and there is no consensus on the sodium (Na) intake level that increases the risk of CV disease in CKD patients. Therefore, we investigated the association between dietary salt intake and CV outcomes in CKD patients.MethodsIn the Korean cohort study for Outcome in patients with CKD (KNOW-CKD), 1,937 patients were eligible for the study, and their dietary Na intake was estimated using measured 24h urinary Na excretion. The primary outcome was a composite of CV events and/or all-cause death. The secondary outcome was a major adverse cardiac event (MACE).ResultsAmong 1,937 subjects, there were 205 (10.5%) events for the composite outcome and 110 (5.6%) events for MACE. Compared to the reference group (urinary Na excretion< 2.0g/day), the group with the highest measured 24h urinary Na excretion (urinary Na excretion ≥ 8.0g/day) was associated with increased risk of both the composite outcome (hazard ratio 3.29 [95% confidence interval 1.00-10.81]; P = 0.049) and MACE (hazard ratio 6.28 [95% confidence interval 1.45-27.20]; P = 0.013) in a cause-specific hazard model. Subgroup analysis also showed a pronounced association between dietary salt intake and the composite outcome in subgroups of patients with abdominal obesity, female, lower estimated glomerular filtration rate (< 60 ml/min per 1.73m2), no overt proteinuria, or a lower urinary potassium-to-creatinine ratio (< 46 mmol/g).ConclusionA high-salt diet is associated with CV outcomes in non-dialysis CKD patients

Adsorption of Lead and Nickel on to Expanded Graphite Decorated with Manganese Oxide Nanoparticles

In this study, expanded graphite (EG) was decorated with manganese oxide nanoparticles (MONPs) by the hydrothermal method, and the newly formed composite (MONPs-EG) was applied as adsorbent for the removal of heavy metals from aqueous solutions. The comparative and competitive adsorption of Pb2+ and Ni2+ (0.01–1.00 mM) on MONPs-EG was investigated. Data from isothermal adsorption of single and binary systems suggested that both Pb2+ and Ni2+ were well described by the Langmuir isotherm, and the maximum adsorption capacities at 298 K were calculated at 0.278 and 0.113 mmol/g for Pb2+ and Ni2+, respectively. In binary systems, a dramatic decrease in adsorption capacity of Ni2+ was observed, while the adsorption capacity of Pb2+ was almost stable, indicating the favorable adsorption of Pb2+ over Ni2+ onto the prepared adsorbent. Kinetics studies of single and binary systems showed that a pseudo-second order model could explain the adsorption processes well. Thermodynamic analysis results demonstrated that the adsorption of these metal ions on the prepared adsorbent is spontaneous and exothermic in nature. The adsorption capacity of MONPs-EG increased significantly in the presence of humic acids. Overall, the results of this study suggest that MONPs-EG can be used effectively as an adsorbent for heavy metals removal from aqueous solutions

Optical coherence tomography of the Tokay gecko (Gekko gecko) eye

Objective To provide images of the anterior and posterior structures of the gecko eye using spectral domain optical coherence tomography (SD-OCT). Animals and procedures Eight ophthalmologically normal Tokay geckos (Gekko gecko) were used. The nose-cloaca distance and body weight were measured for each gecko. Tomographic images were obtained using SD-OCT without the use of anesthetic or mydriatic agents. The central corneal thickness (CCT), the anterior chamber depth (ACD), and the length of the conus papillaris (CP) were manually measured using OCT images. The thickness of the retinal nerve fiber layer (RNFL) around the CP and the retinal thickness in all four quadrants (superior, nasal, inferior, and temporal areas) were automatically measured using the OCT software program. Results The mean values of the nose-cloaca distance and body weight were 13.8 +/- 0.9 cm and 41.3 +/- 9.0 g, respectively. The mean values of CCT, ACD, and CP length were 177.6 +/- 20.9 mu m, 1205.0 +/- 79.9 mu m, and 1546.4 +/- 208.8 mu m, respectively. The mean value of RNFL thickness was 52.0 +/- 8.2 mu m, and the superior region was the thickest. The mean value of total retinal thickness was 202.5 +/- 9.4 mu m, and the temporal region was the thickest. Conclusions Tomographic images of the anterior and posterior segments of the living gecko eye could be obtained using the OCT unit. Multiple retinal layers and anatomical features of the CP were identified.N

Ultrasound biomicroscopic study of the effects of topical latanoprost on the anterior segment and ciliary body thickness in dogs

Objective The goal of this study was to evaluate the effects of topical latanoprost on the anterior segment and ciliary body using ultrasound biomicroscopy (UBM) in dogs. Animals studied This study included six eyes of six clinically normal beagles. Procedures UBM scans were performed on six sedated dogs before and 2 h after topical latanoprost instillation. From the next day on, latanoprost was topically applied twice daily for 7 days. After 1 week of instillation, the UBM scans were repeated. The ciliary body thickness (CBT) and the anterior segment parameters, including the iridocorneal angle (ICA), the width of the ciliary cleft (CC) entry, the length of the CC, and the width of the mid-CC, were measured. Results The topical latanoprost decreased the ICA and CC entry width and increased the mid-CC width without any significant alterations in the CC length. There were time-dependent alterations in the CBT: a reduction in the CBT after 2 h of instillation and rebound thickening after 1 week of instillation. Conclusions The topical latanoprost widened the ciliary cleft despite the narrowing of the ICA and CC entry. Time-dependent alterations in the CBT were demonstrated by the UBM and might be a reflection of the mechanism of the uveoscleral outflow enhancement induced by the topical latanoprost.N

Atypical antibiotic-responsive Staphylococcus pseudintermedius-associated tumor-like meibomitis in the upper eyelid: A case report of two dogs

ObjectiveTo present the clinical signs and treatment methods for atypical tumor-like meibomitis in two dogs. Animals StudiedA 4-year-old castrated-male Coton de Tulear (Case 1) and a 6-year-old spayed-female Maltese dog (Case 2). ProcedureFull ophthalmic examination revealed a well-circumscribed, firm, and raised solitary mass on the upper eyelid of the left (Case 1) and right eye (Case 2). Case 1 showed a recurrent mass with a diameter of 2-3 mm, which was excised by the referring veterinarian. The possibility of meibomian gland involvement was suggested histopathologically. Case 2 had a history of blepharitis treated with systemic corticosteroids 4 years ago. ResultsTopical and systemic antibiotics and anti-inflammatory drugs were administered to reduce inflammation and prevent secondary infections. In Case 1, the mass appeared static at the beginning of medication; however, after stopping antibiotics while tapering steroids, the mass increased in size and was associated with suppurative discharge. In Case 2, the mass continued to grow despite treatment, showing a similar infection pattern. Cytological examination revealed neutrophilic inflammation with cocci infection, and bacterial culture confirmed the presence of Staphylococcus pseudintermedius in both cases. When steroid administration was stopped and antibiotic administration was initiated according to the results of the antibiotic susceptibility test, the mass rapidly decreased in size and completely disappeared. There was no recurrence on follow-up. ConclusionsA unilateral antibiotic-responsive tumor-like solitary mass on the upper eyelid resolved without surgical treatment. Medical treatment must be considered when treating atypical eyelid masses, and the use of appropriate antibiotics through antibiotic susceptibility testing is important.N

Artificial Intelligence-Enhanced Smartwatch ECG for Heart Failure-Reduced Ejection Fraction Detection by Generating 12-Lead ECG

Background: We developed and validated an artificial intelligence (AI)-enabled smartwatch ECG to detect heart failure-reduced ejection fraction (HFrEF). Methods: This was a cohort study involving two hospitals (A and B). We developed the AI in two steps. First, we developed an AI model (ECGT2T) to synthesize ten-lead ECG from the asynchronized 2-lead ECG (Lead I and II). ECGT2T is a deep learning model based on a generative adversarial network, which translates source ECGs to reference ECGs by learning styles of the reference ECGs. For this, we included adult patients aged ≥18 years from hospital A with at least one digitally stored 12-lead ECG. Second, we developed an AI model to detect HFrEF using a 10 s 12-lead ECG. The AI model was based on convolutional neural network. For this, we included adult patients who underwent ECG and echocardiography within 14 days. To validate the AI, we included adult patients from hospital B who underwent two-lead smartwatch ECG and echocardiography on the same day. The AI model generates a 10 s 12-lead ECG from a two-lead smartwatch ECG using ECGT2T and detects HFrEF using the generated 12-lead ECG. Results: We included 137,673 patients with 458,745 ECGs and 38,643 patients with 88,900 ECGs from hospital A for developing the ECGT2T and HFrEF detection models, respectively. The area under the receiver operating characteristic curve of AI for detecting HFrEF using smartwatch ECG was 0.934 (95% confidence interval 0.913–0.955) with 755 patients from hospital B. The sensitivity, specificity, positive predictive value, and negative predictive value of AI were 0.897, 0.860, 0.258, and 0.994, respectively. Conclusions: An AI-enabled smartwatch 2-lead ECG could detect HFrEF with reasonable performance

Left Ventricular Diastolic Dysfunction and Progression of Chronic Kidney Disease: Analysis of KNOW-CKD Data

Background Few studies have examined the association between the early diastolic mitral inflow velocity/early diastolic mitral annulus velocity ratio (E/e') and chronic kidney disease progression. Methods and Results We reviewed data from 2238 patients with nondialysis chronic kidney disease from the KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease); data from 163 patients were excluded because of missing content. A >50% decrease in estimated glomerular filtration rate from baseline, doubling of serum creatinine, or dialysis initiation and/or kidney transplantation were considered renal events. At baseline, median (interquartile range) ejection fraction and E/e' were 64.0% (60.0%-68.0%) and 9.1 (7.4-11.9), respectively. Proportions of ejection fraction <50% and E/e' >= 15 were 1.3% and 9.6%, respectively. More than one quarter of patients (27.2%) had an estimated glomerular filtration rate <30 mL/min per 1.73 m(2). During the mean 59.1-month follow-up period, 724 patients (34.9%) experienced renal events. In multivariable Cox proportional hazard regression analysis, the hazard ratio with 95% CI per 1-unit increase in E/e' was 1.027 (1.005-1.050; P=0.016). Penalized spline curve analysis yielded a suggested threshold of E/e' for renal events of 12; in our data set, the proportion of E/e' >= 12 was 4.1%. Conclusions Increased E/e' was associated with an increased hazard of renal events, suggesting that diastolic heart dysfunction is a novel risk factor for chronic kidney disease progression.N

Low Klotho/Fibroblast Growth Factor 23 Ratio Is an Independent Risk Factor for Renal Progression in Chronic Kidney Disease: Finding From KNOW-CKD

BackgroundWe aimed to evaluate soluble Klotho and circulating fibroblast growth factor 23 (FGF23) ratio as a risk factor for renal progression, cardiovascular (CV) events, and mortality in chronic kidney disease (CKD). MethodsWe analyzed 2,099 subjects from a CKD cohort whose soluble Klotho and C-terminal FGF23 levels were measured at enrollment. The Klotho to FGF23 ratio was calculated as Klotho values divided by FGF23 values + 1 (hereinafter called the Klotho/FGF23 ratio). Participants were categorized into quartiles according to Klotho/FGF23 ratio. The primary outcome was renal events, defined as the doubling of serum creatinine, 50% reduction of estimated glomerular filtration rate from the baseline values, or development of end-stage kidney disease. The secondary outcomes consisted of CV events and death. Changes in CV parameters at the time of enrollment and during follow-up according to the Klotho/FGF23 ratio were also examined. ResultsDuring the follow-up period of 64.0 +/- 28.2 months, 735 (35.1%) and 273 (13.0%) subjects developed renal events and composite outcomes of CV events and death, respectively. After adjustment, the first (HR: 1.36; 95% CI: 1.08-1.72, P = 0.010) and second (HR: 1.45; 95% CI: 1.15-1.83, P = 0.002) quartiles with regard to the Klotho/FGF23 ratio showed elevated risk of renal events as compared to the fourth quartile group. There was no significant association between Klotho/FGF23 ratio and the composite outcome of CV events and death. The prevalence of left ventricular hypertrophy and vascular calcification was higher in the low Klotho/FGF23 ratio quartiles at baseline and at the fourth-year follow-up. ConclusionsLow Klotho/FGF23 ratio was significantly associated with increased renal events in the cohort of Korean predialysis CKD patients.N