Structural equation models to infer relationships between energy-related blood metabolites and milk daily energy output in Holstein cows.

During lactation, high-yielding cows experience metabolic disturbances due to milk production. Metabolic monitoring offers valuable insights into how cows manage these challenges throughout the lactation period, making it a topic of considerable interest to breeders. In this study, we used Bayesian networks to uncover potential dependencies among various energy-related blood metabolites, i.e., glucose, urea, beta-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA), cholesterol (CHOL), and daily milk energy output (dMEO) in 1,254 Holstein cows. The inferred causal structure was then incorporated into structural equation models (SEM) to estimate heritabilities and additive genetic correlations among these phenotypes using both pedigree and genotypes from a 100k chip. Dependencies among traits were determined using the Hill-Climbing algorithm, implemented with the posterior distribution of the residuals obtained from the standard multiple-trait model. These identified relationships were then used to construct the SEM, considering both direct and indirect relationships. The relevant dependencies and path coefficients obtained, expressed in units of measurement variation of 1σ, were as follows: dMEO → CHOL (0.181), dMEO → BHB (-0.149), dMEO → urea (0.038), glucose → BHB (-0.55), glucose → urea (-0.194), CHOL → urea (0.175), BHB → urea (-0.049), and NEFA → urea (-0.097). Heritabilities for traits of concern obtained with SEM ranged from 0.09 to 0.2. Genetic correlations with a minimum 95% probability (P) of the posterior mean being >0 for positive means or <0 for negative means include those between dMEO and glucose (-0.583, P = 100), dMEO and BHB (0.349, P = 99), glucose and CHOL (0.325, P = 100), glucose and NEFA (-0.388, P = 100), and NEFA and BHB (0.759, P = 100). The results of this analysis revealed the existence of recursive relationships among the energy-related blood metabolites and dMEO. Understanding these connections is paramount for establishing effective genetic selection strategies, enhancing production and animal welfare.

Dairy cows face significant metabolic challenges during the different phases of the production cycle. One of their primary issues revolves around meeting the elevated energy demands, encompassing essential maintenance requirements and the energy required for milk production. In this context, monitoring of energy-related blood metabolites along lactation may be useful to detect metabolic disturbances. To date, no study is available on the investigation of putative recursive relationships among energy-related blood metabolites and milk daily energy output. The use of structural equation models presents an innovative approach to enhance our understanding of these complex relationships. This approach allows us to gain a better insight into the metabolic pathways and processes involved in energy metabolism. The findings of this study uncovered recursive relationships between energy-related blood metabolites and daily milk energy output. Grasping these interactions is crucial for developing effective breeding strategies focused on selecting more resistant and resilient cows, which have the capacity to better cope with metabolic distress along lactation.

Sulfonated-polypyrene aniline/polyaniline composite fortified with Cu-GQD@ZIF8 as an electrochemical enzymatic urea biosensor.

The determination of urea concentration is essential for human health owing to its crucial role in the ability to metabolize nitrogen-containing substances. This study developed new electrochemical enzymatic detection systems via the synergistic effect of the superior features of novel electropolymerizable pyranine-aniline (PA, 4), polyaniline (PANI) compounds, graphene quantum dots (GQDs) and zeolitic imidazolate framework-8 (ZIF8). The novel compound 4 was characterized via1H-NMR, 13C-NMR, FTIR, and MALDI-TOF mass spectroscopies. Furthermore, Cu-GQD@ZIF8 hybrid materials containing GQD and integrated electroactive Cu metal were prepared in this study. The surface morphology of the prepared Cu-GQD@ZIF8 hybrid material was investigated through microscopic methods such as SEM and TEM, and chemical characterizations were performed using FTIR, XPS, XRD, and TGA analyses. After the characterization of the novel materials, the urease (Urs) enzyme was bound to the new modified electrode surface. Next, the enzymatic biosensor properties of the Urs/Cu-GQD@ZIF8/PANI/PA/GCE sensor electrode for urea detection via reduction of PANI were investigated by DPV and CV techniques. The LOD and LOQ values of the presented sensor were calculated to be 0.77 µM and 2.31 µM, respectively, in the linear range of 1.0-80.0 µM, based on DPV measurements. The presented biosensor system determined the amount of urea in an artificial serum sample, and its accuracy was confirmed via the recovery test and GC-MS analysis.

The assessment of zeolite addition to diets with or without urea on some productive and physiological indicators in Awassi lambs.

BACKGROUND: Interest is growing in the search for alternatives to traditional feed additives, so this study aimed to investigate the effect of adding zeolite to the concentrate diets of Awassi lambs with or without urea on growth performance, nutrient digestion, and health status. A total of 45 Awassi lambs similar in weight (24 ± 2 kg) and age (3 months ± 4 days) were divided into three groups: the first group (G1) fed on a concentrate diet supplemented with 1% urea; the second group (G2) fed on the concentrate diet supplemented with 1% urea and 3% zeolite, and the third group (G3) fed on a urea-free diet supplemented with 3% zeolite. RESULTS: The results showed a significant increase (P ≤ 0.05) in final live weight, daily and total weight gain for group G2 compared to groups G1and G3, with a significant superiority (P ≤ 0.05) of group G3 over the control group G1. Significant improvement (P < 0.05) was also observed in feed consumption and feed conversion ratio in diets supplemented with zeolite for groups G2 and G3 compared to the control group G1. Additionally, there was a significant increase (P ≤ 0.05) in nutrient digestion and nutritional value in the diet of group G2 containing urea with added zeolite compared to groups G1 and G3. Zeolite did not affect the levels of glucose, triglycerides, cholesterol, and albumin in the blood, but a significant increase (P ≤ 0.05) in total blood protein level and a significant decrease (P ≤ 0.05) in blood urea level were noted for groups G2 and G3 compared to the control group G1. CONCLUSIONS: Adding zeolite to urea-containing concentrate diets improved growth rates and nutrient digestion, of Awassi lambs. In diets without urea, zeolite improved growth rates without affecting nutrient digestion coefficients, in both types of diets, zeolite increased total protein levels and decreased blood urea levels, with all physiological indicators in lambs blood remaining within normal limits.

Metabolic Profile in Rats during Long-Term Restriction of Motor Activity.

We performed a comprehensive study of protein (total protein, medium-molecular-weight peptides, creatinine, and urea), purine (uric acid), and lipid (cholesterol, triglycerides) metabolism, activity of AST, ALT, and acid phosphatase in blood plasma of white male rats under conditions of restriction of motor activity up to 28 days. Patterns of changes in metabolic profile during hypokinesia were established: prevalence of catabolic processes and atherogenic shifts in the lipid spectrum with maximum manifestation on 14-21 days of the experiment.

Weak association between urea-creatinine ratio and c-reactive protein with nutritional risk in hospitalized patients with COVID-19: A cross-sectional study.

BACKGROUND: COVID-19 is a systemic infection with a significant impact on nutrition risk and the hematopoietic system. The neutrophil-lymphocyte ratio (NLR) may have prognostic value in determining severe cases of COVID-19 and the urea-creatinine ratio (UCR) is currently being studied as a potential biomarker of catabolism associated with critical illness. The aim was to assess the association between the NLR, UCR and C-reactive protein (CRP) with nutritional risk in hospitalized patients with COVID-19. METHODS: This is a retrospective cross-sectional study that assessed 589 hospitalized patients with COVID-19, 18 years of age or older, of both sexes. Nutritional risk was assessed by Nutritional Risk Screening (NRS, 2002) and NLR by neutrophils divided by lymphocyte count. The UCR was calculated by the ratio between urea and creatinine and quantified by the calorimetric biochemical method and CRP by the immunoturbidimetric method. Differences between groups were applied by the Mann-Whitney U test and the automated binary regression test. RESULTS: Of the 589 patients, 87.4% were at nutritional risk. When evaluating patients admitted to the ICU, 91.9% were at nutritional risk. Patients with NRS ≥3 are older, with lower body mass and BMI, higher NLR and UCR and lower CRP values. However, 73% of patients admitted to the ward were at nutritional risk, and only age differed between groups, being higher in patients with NRS ≥3. Logistic regression showed a weak association between nutritional risk in NRS and UCR (Model 1) (OR = 0.96, 95%CI: 0.94-0.99, p = 0.003) and NRS with CRP (Model 1) (OR = 1.01, 95%CI: 1.00-1.02, p < 0.001) in patients in the ICU. On the other hand, the logistic regression in ward patients found association only for CRP in both models (Model 1, OR = 1.01, 95%CI: 1.00-1.01, p = 0.041) and (Model 2, OR = 1.01, 95%CI: 1.00-1.01, p = 0.031). CONCLUSION: We found a weak association between nutritional risk and UCR and CRP levels in patients admitted to the ICU, while in the ward patients the nutritional risk also had weak association with CRP.

Association between serum uric acid levels with essential hypertension and its metabolic variables in Hospital Universiti Sains Malaysia.

INTRODUCTION: Hyperuricaemia is common in essential hypertension with varying results in different populations. This study sought to ascertain the association between serum uric acid levels and essential hypertension in Hospital Universiti Sains Malaysia (HUSM). MATERIALS AND METHODS: A case-control study design involving 132 subjects (88 subjects of hypertension patients for case group and 44 subjects for control group) aged 18 to 40 years old of both genders was conducted at HUSM primary care clinic and physician clinic from May 2020 to May 2021. Blood samples were collected from each of the case and control subjects and analysed for serum uric acid, urea, creatinine, total cholesterol, triglycerides, LDL and HDL on chemical analyser Architect c8000. The data were analysed by using SPSS Statistics 26.0 version. RESULTS: The proportion of subjects with hyperuricaemia in the case group was 48.9%. A significant difference in the uric acid levels between the case group (390.64±92.65µmol/L) and control group (352.09±86.07µmol/L), (p<0.05) was observed. There was no significant difference in the serum uric acid mean ± SD based on the duration of hypertension (<5 years and ≥5 years), (p=0.331) and stages of hypertension (p>0.05). In case group, significant correlations were established between uric acid and triglycerides (r=0.255, p<0.05), uric acid and HDL (r= -0.223, p<0.05), uric acid and urea (r=0.299, p<0.05), uric acid and creatinine (r=0.486, p<0.01). No correlation among uric acid and total cholesterol levels (p>0.05), uric acid and LDL (p>0.05). Serum uric acid was a vital variable in developing hypertension (p<0.05) but not when adapted for age and body mass index (BMI) (p>0.05). CONCLUSION: Serum uric acid was significantly elevated in essential hypertension. The significant associations were established between uric acid and triglycerides, HDL, urea and creatinine in essential hypertension. Serum uric acid was a vital variable to develop hypertension, but the association was weakened by other co-founders as age and BMI. A large-scale population-based study is required to truly conclude the association between serum uric acid levels and essential hypertension in our population.

Factors influencing accelerated aging in patients with type 2 diabetes mellitus and coronary heart disease.

Objective: To investigate the factors influencing accelerated aging in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD). Methods: A total of 216 patients diagnosed with T2DM and CHD between August 2019 and August 2023 at Xuzhou Central Hospital were selected. Patients were divided into an aging group and a non-aging group, based on the positive or negative values of phenotypic age acceleration (PhenoAgeAccel). Logistic regression analysis was conducted. Variables that had a univariate analysis P< 0.05 were included in the multivariate analysis to identify factors influencing aging in patients with T2DM and CHD, and the area under the curve of the model was reported. Results: This study included 216 patients, with 89 in the accelerated aging group, and 127 in the non-accelerated aging group. The average age of patients was 70.40 (95% CI: 69.10-71.69) years, with 137 males (63.4%). Compared with the non-accelerated aging group, patients in the accelerated aging group were older, with a higher proportion of males, and a higher prevalence of hypertension, stable angina pectoris, and unstable angina pectoris. Multivariate Logistic regression analysis indicated that the absolute value of neutrophils (NEUT#), urea (UREA), adenosine deaminase (ADA), and the triglyceride-glucose index (TyG) were risk factors for accelerated aging, while cholinesterase (CHE) was a protective factor. For each unit increase in NEUT#, UREA, ADA, and TyG, the risk of aging increased by 64%, 48%, 10%, and 789%, respectively. The overall area under the receiver operating characteristic (ROC) curve of the model in the training set was 0.894, with a 95% confidence interval (CI) of 0.851-0.938. Conclusion: NEUT#, CHE, UREA, ADA, and TyG are predictors of accelerated aging in patients with T2DM and CHD, with the model showing favorable overall predictive performance.

Ammonia and urea metabolism in acute liver failure: A multicentre cohort study.

BACKGROUND & AIMS: Ammonia is metabolized into urea in the liver. In acute liver failure (ALF), ammonia has been associated with survival. However, urea variation has been poorly studied. METHODS: Observational cohort including ALF patients from Curry Cabral Hospital (Lisbon, Portugal) and Clinic Hospital (Barcelona, Spain) between 10/2010 and 01/2023. The United States ALF Study Group cohort was used for external validation. Primary exposures were serum ammonia and urea on ICU admission. Primary endpoint was 30-day transplant-free survival (TFS). Secondary endpoint was explanted liver weight. RESULTS: Among 191 ALF patients, median (IQR) age was 46 (32; 57) years and 85 (44.5%) were males. Overall, 86 (45.0%) patients were transplanted and 75 (39.3%) died. Among all ALF patients, following adjustment for age, sex, body weight, and aetiology, higher ammonia or lower urea was independently associated with higher INR on ICU admission (p < .009). Among all ALF patients, following adjustment for sex, aetiology, and lactate, higher ammonia was independently associated with lower TFS (adjusted odds ratio (95% confidence interval [CI]) = 0.991 (0.985; 0.997); p = .004). This model predicted TFS with good discrimination (area under receiver operating curve [95% CI] = 0.78 [0.75; 0.82]) and reasonable calibration (R2 of 0.43 and Brier score of 0.20) after external validation. Among transplanted patients, following adjustment for age, sex, actual body weight, and aetiology, higher ammonia (p = .024) or lower (p < .001) urea was independently associated with lower explanted liver weight. CONCLUSIONS: Among ALF patients, serum ammonia and urea were associated with ALF severity. A score incorporating serum ammonia predicted TFS reasonably well.

Allo-Hemodialysis, a Novel Dialytic Treatment Option for Patients with Kidney Failure: Outcomes of Mathematical Modelling, Prototyping, and Ex Vivo Testing.

It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer's dialysate compartment counter-currently to the blood of a healthy subject (referred to as a "buddy") flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea Kt/V. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard Kt/V of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform ex vivo experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine's ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future in vivo studies in animals with and without kidney failure.

Urea Level and Depression in Patients with Chronic Kidney Disease.

Depression is common in patients with chronic kidney disease (CKD). Experimental studies suggest the role of urea toxicity in depression. We assessed both the incidence of antidepressant prescriptions and depressive symptoms (measured by CESD (Center for Epidemiologic Depression) scale) in 2505 patients with CKD (Stage 3-4) followed up over 5 years in the Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) cohort. We used a joint model to assess the association between the serum urea level and incident antidepressant prescriptions, and mixed models for the association between the baseline serum urea level and CESD score over the 5-year follow-up. Among the 2505 patients, 2331 were not taking antidepressants at baseline. Of the latter, 87 started taking one during a median follow-up of 4.6 years. After adjustment for confounding factors, the hazard ratio for incident antidepressant prescription associated with the serum urea level (1.28 [95%CI, 0.94,1.73] per 5 mmol/L increment) was not significant. After adjustment, the serum urea level was associated with the mean change in the CESD score (ß = 0.26, [95%CI, 0.11,0.41] per 5 mmol/L increment). Depressive symptoms burden was associated with serum urea level unlike depression events. Further studies are needed to draw firm conclusions and better understand the mechanisms of depression in CKD.

[Dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis assessed by bedside ultrasound and their correlation with blood urea/creatinine ratio].

OBJECTIVE: To investigate the dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis by bedside ultrasound and their correlation with the ratio of blood urea/creatinine ratio (UCR) in 7 days after intensive care unit (ICU) admission. METHODS: A prospective observational study was conducted. A total of 55 patients with sepsis admitted to ICU of General Hospital of Ningxia Medical University from June 2022 to February 2023 were selected as the research objects. General information, laboratory indicators [urea, serum creatinine (SCr), and UCR] on days 1, 4, and 7 of ICU admission, and prognostic indicators were observed. Bedside ultrasound was used to assess the dynamic changes of diaphragm morphology [including diaphragmatic excursion (DE), end-inspiratory diaphragm thickness (DTei), and end-expiratory diaphragm thickness (DTee)] on days 1, 4, and 7 of ICU admission, as well as limb skeletal muscle (quadriceps femoris) morphology [including rectus femoris-muscle layer thickness (RF-MLT), vastus intermedius-muscle layer thickness (VI-MLT), and rectus femoris-cross sectional area (RF-CSA)]. Diaphragm thickening fraction (DTF) and RF-CSA atrophy rate were calculated, and the incidence of diaphragm and limb skeletal muscle dysfunction was recorded. The correlation between ultrasound morphological parameters of diaphragm and quadriceps and UCR at each time points in 7 days after ICU admission was analyzed by Pearson correlation. RESULTS: A total of 55 patients with sepsis were included, of which 29 were in septic shock. As the duration of ICU admission increased, the incidence of diaphragm dysfunction in patients with sepsis increased first and then decreased (63.6%, 69.6%, and 58.6% on days 1, 4, and 7 of ICU admission, respectively), while the incidence of limb skeletal muscle dysfunction showed an increasing trend (54.3% and 62.1% on days 4 and 7 of ICU admission, respectively), with a probability of simultaneous occurrence on days 4 and 7 of ICU admission were 32.6% and 34.5%, respectively. The UCR on day 7 of ICU admission was significantly higher than that on day 1 [121.77 (95.46, 164.55) vs. 97.00 (70.26, 130.50)], and RF-CSA atrophy rate on day 7 was significantly higher than that on day 4 [%: -39.7 (-52.4, -22.1) vs. -26.5 (-40.2, -16.4)]. RF-CSA was significantly lower on day 7 compared to day 1 [cm2: 1.3 (1.0, 2.5) vs. 2.1 (1.7, 2.9)], with all differences being statistically significant (all P < 0.05). Pearson correlation analysis showed that RF-CSA on day 7 of ICU admission was negatively associated with the UCR on the same day (r = -0.407, P = 0.029). CONCLUSIONS: Diaphragmatic dysfunction in patients with sepsis occurred early and can be improved. Limb skeletal muscle dysfunction occurred relatively later and progresses progressively. The RF-CSA on day 7 of ICU admission may be a reliable measure of limb skeletal muscle dysfunction in patients with sepsis, can be an indicator of early identification and diagnosis of ICU-acquired weakness (ICU-AW). Continuous loss of muscle mass occurring in septic patients is mainly associated with persistent organismal catabolism, and undergoes significant changes around a week in ICU.

Kidney function, but not nitrogen excretion, differs between Brown Swiss and Holstein dairy cows.

Brown Swiss (BS) cows have greater urea concentrations in milk and blood compared with Holstein (HO) cows. We tested the hypothesis that BS and HO cows differ in kidney function and nitrogen excretion. Blood, saliva, urine, and feces were sampled in 31 multiparous BS and 46 HO cows kept under identical feeding and management conditions. Samples were collected at different lactational stages after the monthly DHIA control test-day. To test the glomerular filtration rate (GFR) and urea excretion, concentrations of creatinine and urea were measured in serum, urine, and saliva. As an additional marker to estimate GFR, we determined symmetric dimethylarginine (SDMA) in serum. Feces were analyzed for DM content and nitrogen concentration. Data on milk urea and protein concentrations and daily milk yield were obtained from the monthly DHIA test-day records. The effects of breed, time, and parity number on blood, saliva, urine, feces, and milk parameters were evaluated with the GLM procedure of SAS, with breed, time, and parity number as fixed effects. Differences between BS and HO were assessed by the Tukey-corrected t-test. Concentrations of urea, creatinine, and SDMA in serum, were greater in BS than in HO cows: 5.46 ± 0.19 versus 4.72 ± 0.13 mmol/L (urea), 105.96 ± 2.23 versus 93.07 ± 1.50 mmol/L (creatinine), and 16.78 ± 0.69 versus 13.39 ± 0.44 µg/dL (SDMA). We observed a greater urea concentration in BS cows (25.8 ± 0.7 vs. 21.8 ± 0.7 mg/dL) and protein content in milk (3.70% ± 0.08% vs. 3.45% ± 0.07%) than in HO cows. Urea and creatinine concentrations in urine and saliva did not differ between breeds. No differences between BS and HO were observed for milk yield, fecal DM, and fecal nitrogen content. Dry matter intake and BW were similar in BS and HO cows. Despite greater urea, creatinine, and SDMA concentrations in blood, as well as a higher milk urea content in BS compared with HO, respective concentrations in urine did not differ between breeds. In conclusion, our results demonstrate a lower renal GFR in BS compared with HO cows, thereby contributing to the greater plasma urea concentration in BS cows. However, estimation of nitrogen excretion via milk, urine, and feces does not entirely reflect nitrogen turnover within the animal.

Multivariate anomaly detection models enhance identification of errors in routine clinical chemistry testing.

OBJECTIVES: Conventional autoverification rules evaluate analytes independently, potentially missing unusual patterns of results indicative of errors such as serum contamination by collection tube additives. This study assessed whether multivariate anomaly detection algorithms could enhance the detection of such errors. METHODS: Multivariate Gaussian, k-nearest neighbours (KNN) distance, and one-class support vector machine (SVM) anomaly detection models, along with conventional limit checks, were developed using a training dataset of 127,451 electrolyte, urea, and creatinine (EUC) results, with a 5 % flagging rate targeted for all approaches. The models were compared with limit checks for their ability to detect atypical EUC results from samples spiked with additives from collection tubes: EDTA, fluoride, sodium citrate, or acid citrate dextrose (n=200 per contaminant). The study additionally assessed the ability of the models to identify 127,449 single-analyte errors, a potential weakness of multivariate models. RESULTS: The KNN distance and SVM models outperformed limit checks for detecting all contaminants (p-values <0.05). The multivariate Gaussian model did not surpass limit checks for detecting EDTA contamination but was superior for detecting the other additives. All models surpassed limit checks for identifying single-analyte errors, with the KNN distance model demonstrating the highest overall sensitivity. CONCLUSIONS: Multivariate anomaly detection models, particularly the KNN distance model, were superior to the conventional approach for detecting serum contamination and single-analyte errors. Developing multivariate approaches to autoverification is warranted to optimise error detection and improve patient safety.

Moringa oleifera leaf extracts improve exercise performance in young male adults: A pilot study.

BACKGROUND: Moringa oleifera leaves are rich in bioactive substances. PURPOSE: The purpose of this study was to evaluate the effects of Moringa oleifera leaf aqueous extract supplements on energy metabolism and antioxidant function in young male adults. METHODS: Forty-four young male adults (26.3 ± 3.5 years) were randomly assigned to two groups: a supplement group (n = 23) receiving aqueous extract of Moringa oleifera leaves and a placebo group (n = 21). The supplementation period lasted for 30 days. Baseline measurements were taken at the beginning of the study, and further measurements were taken at the end of the supplementation period. Changes in upper- and lower-body strength, treadmill endurance, and certain blood biochemical parameters were evaluated. RESULTS: After 30 days of supplementation, participants in the supplement group exhibited enhanced performance in push-ups and treadmill exhaustion tests compared to the placebo group. Levels of glucose, urea, malondialdehyde, and glutathione peroxidase activity in serum were also improved in the supplement group. CONCLUSION: The findings suggest that Moringa oleifera leaf aqueous extracts have the potential to improve post-exercise energy metabolism and antioxidant function in young male adults.

Evaluation of Determinants to Achieve Target Urea Reduction Ratio on Maintenance Hemodialysis Patients in Bangladesh.

Among patients with chronic kidney disease stage-5 who are treated with dialysis, the urea clearance during hemodialysis is a determinant of the mortality. Decreased serum albumin, serum calcium but increased phosphorus is associated with reduction of URR and mortality in these patients. This study was to compare two groups Urea Reduction Ratio (URR) and different type of biochemical parameters. URR was aimed to target according to Kidney Disease Outcomes Quality Initiative (KDOQI) guideline. This study was an observational study was carried out in the department of Nephrology. Serum Albumin, serum calcium, phosphate, hemoglobin and pre dialysis urea, post dialysis urea were measured from blood sample. URR was calculated by = (1- postdialysis urea/predialysis urea) × 100. Among the patients who under went hemodialysis, 17.31% patients URR was more than 65.0% and Mean±SD of URR was 67.21±1.9%. On the other hand, 82.68% patients URR was less than 65.0% and Mean±SD of URR was 57.4±5.2%. Most of the Biochemical parameters in this study were significantly different between two groups. Where as, there was no significant difference in Age, Sex, Body Mass Index (BMI). The URR is an accurate indicator, can help determination of adequate dialysis. This study aimed to find out the mean value of the urea reduction ratio and the association of biochemical parameters among End Stage Renal Disease (ESRD) patients on maintenance hemodialysis.

Comparative study on the quality control effectiveness of AI-PBRTQC and traditional PBRTQC model in identifying quality risks.

Introduction: We compared the quality control efficiency of artificial intelligence-patient-based real-time quality control (AI-PBRTQC) and traditional PBRTQC in laboratories to create favorable conditions for the broader application of PBRTQC in clinical laboratories. Materials and methods: In the present study, the data of patients with total thyroxine (TT4), anti-Müllerian hormone (AMH), alanine aminotransferase (ALT), total cholesterol (TC), urea, and albumin (ALB) over five months were categorized into two groups: AI-PBRTQC group and traditional PBRTQC group. The Box-Cox transformation method estimated truncation ranges in the conventional PBRTQC group. In contrast, in the AI-PBRTQC group, the PBRTQC software platform intelligently selected the truncation ranges. We developed various validation models by incorporating different weighting factors, denoted as λ. Error detection, false positive rate, false negative rate, average number of the patient sample until error detection, and area under the curve were employed to evaluate the optimal PBRTQC model in this study. This study provides evidence of the effectiveness of AI-PBRTQC in identifying quality risks by analyzing quality risk cases. Results: The optimal parameter setting scheme for PBRTQC is TT4 (78-186), λ = 0.03; AMH (0.02-2.96), λ = 0.02; ALT (10-25), λ = 0.02; TC (2.84-5.87), λ = 0.02; urea (3.5-6.6), λ = 0.02; ALB (43-52), λ = 0.05. Conclusions: The AI-PBRTQC group was more efficient in identifying quality risks than the conventional PBRTQC. AI-PBRTQC can also effectively identify quality risks in a small number of samples. AI-PBRTQC can be used to determine quality risks in both biochemistry and immunology analytes. AI-PBRTQC identifies quality risks such as reagent calibration, onboard time, and brand changes.

Association between Body Mass Index and Early Renal Function after Kidney Transplantation: Observational and Mendelian Randomization Study.

INTRODUCTION: The relationship between BMI and early renal function recovery after kidney transplantation is important due to the rising global obesity rates. METHODS: A retrospective study on 320 patients who received allograft kidney transplantation at Guangxi Medical University Hospital explored the BMI-kidney function relationship using various statistical methods. Mendelian randomization (MR) was also employed to investigate causality. RESULTS: Based on the univariate analysis, multivariate linear regression models, and trend analysis, it was found that there were significant positive correlations between BMI and creatinine, urea, and cystatin C on the 7th day after kidney transplantation (p < 0.05). The sensitivity analysis further confirmed these correlations in different gender stratification, adolescents, and adults. However, the positive correlation with cystatin C was only significant in males. Additionally, after conducting smooth curve fitting analysis and threshold saturation analysis, it was revealed that the negative correlation between early renal function recovery was most significant when BMI was between 22.0 and 25.5 kg/m2, and early postoperative renal function may be optimal when BMI was at 22.2 kg/m2. Finally, the MR analysis confirmed a causal relationship between BMI and renal failure, as indicated by the IVW method (p = 0.003), as well as the weighted median estimator (p = 0.004). CONCLUSION: This study on kidney transplant patients found that maintaining a BMI within the range of 22.0-25.5 kg/m2, with an optimal BMI of 22.2 kg/m2, improves early renal function recovery. This correlation holds true for different age-groups and genders. Monitoring and controlling BMI in high-risk patients can enhance post-transplantation renal function.

Metabolomic pattern associated with physical sequelae in patients presenting with respiratory symptoms validates the aestivation concept in dehydrated patients.

Hypertonic dehydration is associated with muscle wasting and synthesis of organic osmolytes. We recently showed a metabolic shift to amino acid production and urea cycle activation in coronavirus-2019 (COVID-19), consistent with the aestivation response. The aim of the present investigation was to validate the metabolic shift and development of long-term physical outcomes in the non-COVID cohort of the Biobanque Québécoise de la COVID-19 (BQC19). We included 824 patients from BQC19, where 571 patients had data of dehydration in the form of estimated osmolality (eOSM = 2Na + 2K + glucose + urea), and 284 patients had metabolome data and long-term follow-up. We correlated the degree of dehydration to mortality, invasive mechanical ventilation, acute kidney injury, and long-term symptoms. As found in the COVID cohort, higher eOSM correlated with a higher proportion of urea and glucose of total eOSM, and an enrichment of amino acids compared with other metabolites. Sex-stratified analysis indicated that women may show a weaker aestivation response. More severe dehydration was associated with mortality, invasive mechanical ventilation, and acute kidney injury during the acute illness. Importantly, more severe dehydration was associated with physical long-term symptoms but not mental long-term symptoms after adjustment for age, sex, and disease severity. Patients with water deficit in the form of increased eOSM tend to have more severe disease and experience more physical symptoms after an acute episode of care. This is associated with amino acid and urea production, indicating dehydration-induced muscle wasting.NEW & NOTEWORTHY We have previously shown that humans exhibit an aestivation-like response where dehydration leads to a metabolic shift to urea synthesis, which is associated with long-term weakness indicating muscle wasting. In the present study, we validate this response in a new cohort and present a deeper metabolomic analysis and pathway analysis. Finally, we present a sex-stratified analysis suggesting weaker aestivation in women. However, women show less dehydration, so the association warrants further study.

Urea to creatinine ratio as a predictor of persistent critical illness.

INTRODUCTION: Persistent critical illness (PCI) is a syndrome in which the acute presenting problem has been stabilized, but the patient's clinical state does not allow ICU discharge. The burden associated with PCI is substantial. The most obvious marker of PCI is prolonged ICU length of stay (LOS), usually greater than 10 days. Urea to Creatinine ratio (UCr) has been suggested as an early marker of PCI development. METHODS: A single-center retrospective study. Data of patients admitted to a general mixed medical-surgical ICU during Jan 1st 2018 till Dec 31st 2022 was extracted, including demographic data, baseline characteristics, daily urea and creatinine results, renal replacement therapy (RRT) provided, and outcome measures - length of stay, and mortality (ICU, and 90 days). Patients were defined as PCI patients if their LOS was >10 days. We used Fisher exact test or Chi-square to compare PCI and non-PCI patients. The association between UCr with PCI development was assessed by repeated measures linear model. Multivariate Cox regression was used for 1 year mortality assessment. RESULTS: 2098 patients were included in the analysis. Patients who suffered from PCI were older, with higher admission prognostic scores. Their 90-day mortality was significantly higher than non-PCI patients (34.58% vs 12.18%, p < 0.0001). A significant difference in UCr was found only on the first admission day among all patients. This was not found when examining separately surgical, trauma, or transplantation patients. We did not find a difference in UCr in different KDIGO (Kidney Disease Improving Global Outcomes) stages. Elevated UCr and PCI were found to be significantly associated with 1 year mortality. CONCLUSION: In this single center retrospective cohort study, UCr was not found to be associated with PCI development.

Circadian rhythm of salivary and serum urea concentration in alpacas and sheep receiving diets with different levels of protein.

All vertebrates possess a daily rhythm, encompassing a comprehensive set of physiological, cognitive, and behavioral patterns that manifest throughout a 24-hour period. The aim of this study was to compare the effect of crude protein (CP) levels in the diet on the daily rhythm of urea in serum (US) and saliva in alpacas and sheep. Ten alpacas and ten sheep, adult, clinically healthy males, were used; they were maintained in natural light conditions and fed ad libitum with two levels of CP (16 and 7%). Blood and saliva samples were taken every 4 h for 48 h. A two-way ANOVA was conducted to analyze the parameters, including adjusted mean rhythm (MESOR), amplitude, and acrophase. It was found that both US and saliva urea exhibited circadian rhythms with a peak during the midday (10:59 - 12:16 h). The MESOR with low CP diets was higher (P < 0.05) in alpacas. The MESOR of urea levels in saliva was greater (P < 0.05) at the highest level of CP in the diet, with no differences between alpacas and sheep (P > 0.05). The amplitude was greater (P < 0.05) in alpacas and at the high level of CP compared to the low level of CP in the diet. Our findings reveal that both serum and saliva urea levels in alpacas and sheep follow a daily rhythm and the MESOR of US was higher in alpacas when they consume food with low CP content, and this difference disappears when CP levels are increased in the diet.