Effects of Mineralocorticoid Receptor Antagonists for Chronic Kidney Disease: A Systemic Review and Meta-Analysis.

BACKGROUND: Mineralocorticoid receptor blockade could be a potential approach for the inhibition of chronic kidney disease (CKD) progression. The benefits and harms of different mineralocorticoid receptor antagonists (MRAs) in CKD are inconsistent. OBJECTIVES: The aim of the study was to summarize the benefits and harms of MRAs for CKD patients. METHODS: We searched MEDLINE, EMBASE, and the Cochrane databases for trials assessing the effects of MRAs on non-dialysis-dependent CKD populations. Treatment and adverse effects were summarized using meta-analysis. RESULTS: Fifty-three trials with 6 different MRAs involving 22,792 participants were included. Compared with the control group, MRAs reduced urinary albumin-to-creatinine ratio (weighted mean difference [WMD], -90.90 mg/g, 95% CI, -140.17 to -41.64 mg/g), 24-h urinary protein excretion (WMD, -0.20 g, 95% CI, -0.28 to -0.12 g), estimated glomerular filtration rate (eGFR) (WMD, -1.99 mL/min/1.73 m2, 95% CI, -3.28 to -0.70 mL/min/1.73 m2), chronic renal failure events (RR, 0.86, 95% CI, 0.79-0.93), and cardiovascular events (RR, 0.84, 95% CI, 0.77-0.92). MRAs increased the incidence of hyperkalemia (RR, 2.04, 95% CI, 1.73-2.40) and hypotension (RR, 1.80, 95% CI, 1.41-2.31). MRAs reduced the incidence of peripheral edema (RR, 0.65, 95% CI, 0.56-0.75) but not the risk of acute kidney injury (RR, 0.94, 95% CI, 0.79-1.13). Nonsteroidal MRAs (RR, 0.66, 95% CI, 0.57-0.75) but not steroidal MRAs (RR, 0.20, 95% CI, 0.02-1.68) significantly reduced the risk of peripheral edema. Steroidal MRAs (RR, 5.68, 95% CI, 1.26-25.67) but not nonsteroidal MRAs (RR, 0.52, 95% CI, 0.22-1.22) increased the risk of breast disorders. CONCLUSIONS: In the CKD patients, MRAs, particularly in combination with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, reduced albuminuria/proteinuria, eGFR, and the incidence of chronic renal failure, cardiovascular and peripheral edema events, whereas increasing the incidence of hyperkalemia and hypotension, without the augment of acute kidney injury events. Nonsteroidal MRAs were superior in the reduction of more albuminuria with fewer peripheral edema events and without the augment of breast disorder events.

New classification system for radical rectal cancer surgery based on membrane anatomy.

BACKGROUND: Total mesorectal excision along the "holy plane" is the only radical surgery for rectal cancer, regardless of tumor size, localization or even tumor stage. However, according to the concept of membrane anatomy, multiple fascial spaces around the rectum could be used as the surgical plane to achieve radical resection. AIM: To propose a new membrane anatomical and staging-oriented classification system for tailoring the radicality during rectal cancer surgery. METHODS: A three-dimensional template of the member anatomy of the pelvis was established, and the existing anatomical nomenclatures were clarified by cadaveric dissection study and laparoscopic surgical observation. Then, we suggested a new and simple classification system for rectal cancer surgery. For simplification, the classification was based only on the lateral extent of resection. RESULTS: The fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia lie side by side around the rectum and form three spaces (medial, middle and lateral), and blood vessels and nerves are precisely positioned in the fascia or space. Three types of radical surgery for rectal cancer are described, as are a few subtypes that consider nerve preservation. The surgical planes of the proposed radical surgeries (types A, B and C) correspond exactly to the medial, middle, and lateral spaces, respectively. CONCLUSION: Three types of radical surgery can be precisely defined based on membrane anatomy, including nerve-sparing procedures. Our classification system may offer an optimal tool for tailoring rectal cancer surgery.

Excess selenium intake is associated with microalbuminuria in female but not in male among adults with obesity: Results from NHANES 2009-2018.

Introduction: Selenium is a critical trace element with antioxidant activities that has been related to the preservation of kidney function. Few studies, however, have looked at the effects of excess selenium on kidneys. The purpose of the present study was performed to investigate the relationship between dietary selenium intake and the prevalence of microalbuminuria in American adults with obesity. Methods: A total of 8,547 participants with obesity in the National Health and Nutrition Examination Survey (NHANES) with the age of 19 years or older were included in the present study. Multivariable regression and subgroup analyses were performed to examine the association between dietary selenium and microalbuminuria in the two genders, separately. A selenium intake above the median was defined as high selenium intake. Results: Dietary selenium intake was significantly higher in men compared to women (139.49 µg/day vs. 101.06 µg/day; P < 0.0001). Among female participants, the prevalence of microalbuminuria was significantly higher in participants with a high selenium intake compared with those without a high selenium intake (13.82 vs. 9.96%; P = 0.008), whereas this difference did not exist in male participants (10.79 vs. 11.97%; P = 0.40). Dietary selenium is not significantly correlated with microalbuminuria (P = 0.68) in the male population, whereas each 1 µg/day of increase in selenium consumption was independently associated with a 6h higher risk of microalbuminuria (OR = 1.006; 95% CI, 1.001-1.011, P = 0.01) in females. Conclusion: According to our research, excessive selenium consumption is positively correlated with microalbuminuria in females with obesity, but not in males with obesity.

Laparoscopic lateral lymph node dissection in two fascial spaces for locally advanced lower rectal cancer.

BACKGROUND: The procedure for lateral lymph node (LLN) dissection (LLND) is complicated and can result in complications. We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure. AIM: To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer (LALRC). METHODS: Cadaveric dissection was performed on 24 pelvises, and the fascial composition related to LLND was observed and described. Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC, and their clinical data were analyzed. RESULTS: The cadaver study showed that the fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery, and the last three fasciae formed two spaces (Latzko's pararectal space and paravesical space) which were the surgical area for LLND. Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients. The median operating time, blood loss and postoperative hospitalization were 178 (152-243) min, 55 (25-150) mL and 10 (7-20) d, respectively. The median number of harvested LLNs was 8.6 (6-12), and pathologically positive LLN metastasis was confirmed in 7 (35.0%) cases. Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case. CONCLUSION: Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible, effective and safe procedure for treating LALRC.

Characterization of aldehydes and hydroxy acids as the main contribution to the traditional Chinese rose vinegar by flavor and taste analyses.

The volatile aroma compounds of traditional Chinese rose vinegar were identified by headspace solid-phase micro extraction gas chromatography-mass spectrometry (HS-SPME-GC-MS) and GC-MS-olfactometry (GC-MS-O), and the metabolites were identified by silylation-GC-MS in this study. A total of 48 and 76 kinds of flavors and metabolites, respectively were detected in this study. Quantitative analysis showed that aldehydes and acids were present in relatively high amounts. Furthermore, the data colleted by the calculated odor activity values (OAVs) suggested that aldehydes are likely to contribute greatly to the aroma of traditional Chinese rose vinegar, especially, nonanal (OAV: 133, rose), 3-methyl-butanal (OAV: 57, apple-like), decanal (OAV: 23, orange peel), heptanal (OAV: 17, fruity), and dodecanal (OAV: 4-9, violet scents). Moreover, among the detected nonvolatile acids, 14 kinds of hydroxy acids, such as lactic acid, citric acid, 3-phenyllactic acid (PLA) and d-gluconic acid were detected in rose vinegar. The acids provide a well buffer system, not only greatly reduce the irritation of acetic acid, but also improve the flavor of rose vinegar. This study suggests that the fragrance and sour notes in rose vinegar are from aldehydes and hydroxy acids.

Proteinase and glycoside hydrolase production is enhanced in solid-state fermentation by manipulating the carbon and nitrogen fluxes in Aspergillus oryzae.

Soy sauce materials of soybean meal and wheat bran were evaluated in solid-state (koji) fermentation (SSF) and submerged fermentation (SmF) by Aspergillus oryzae. Proteinase production in SSF (2331 ±â€¯39 U g-1) was about 4.9 times higher than that in SmF (477 ±â€¯13 U g-1), and glycoside hydrolase was approximately 2 times higher in SSF than that in SmF. In addition, protein expression of iTRAQ analysis deepens our understanding of the secreting mechanism. Abundant proteinases (dipeptidase, dipeptidyl aminopeptidase, puromycin-sensitive aminopeptidase, Xaa-pro aminopeptidase, neutral protease 2 and leucine aminopeptidase 2), along with the glycoside hydrolase (glycoamylase, glucosidase and ß-xylanase) were secreted at the late stage of SSF, but tripeptidyl peptidase sed 2 was proposed as an indispensable protease in SmF or the early stage of SSF. Several metabolites associated with the carbon flux and amino acid biosynthesis were proved to be regulated by the proteinase and glycoside hydrolase production.

Extracellular Proteome Analysis and Flavor Formation During Soy Sauce Fermentation.

Aspergillus oryzae is an excellent strain for soy sauce fermentation because of its complicated enzyme system, especially protease. The aim of this study was to investigate the key enzymes and flavors during soy sauce fermentation, and a comparative assessment of extracellular enzymes during various fermentation stages at the proteomic level via iTRAQ analysis is presented. Many important enzymes related to the amino acid and glucose metabolisms participated in the material decomposition under high-salt stress. Dipeptidase, dipeptidyl aminopeptidase, leucine aminopeptidase, aspartic protease pep1, and extracellular metalloproteinase played positive roles during the early stage of soybean mash fermentation, whilst leucine aminopeptidase A and extracellular metalloproteinase NpI were the dominant proteolytic enzymes during the later period of fermentation. At the same time, ß-glucosidase and ß-xylanase exerted great effects upon glucose metabolism throughout the fermentation process. The results show that protease and amylolytic enzymes are complementary in the formation of flavors such as alcohols, acids, esters, aldehydes, furans, and pyrazines during soy sauce fermentation.

Reuse of sewage sludge as a catalyst in ozonation--efficiency for the removal of oxalic acid and the control of bromate formation.

Sewage derived sludge is produced with an annual amount increase of 2% all over the world and it is an urgent issue to be addressed by human being. In the present study, sludge was converted into sludge-based catalyst (SBC) with ZnCl2 as activation agent and characterized by several methods (e.g., scanning electron microscope, X-ray photoelectron spectroscope and Fourier transform infrared spectroscope). Then it was used as a catalyst to enhance the removal of refractory organic matter, oxalic acid, and to control the formation of bromate (BrO3-) in bench semi-continuous ozonation experiments. The effects of various operating parameters on the control of BrO3- formation were investigated. Furthermore, the mechanism for the enhancement of organic matter removal and the control of BrO3- formation was discussed as well. Results indicate that the combination of SBC with ozone shows a strong synergistic effect, resulting in a notable improvement on oxalic acid removal. A crucial surface reaction mechanism for the enhancement of organic matter removal is proposed on the basis of negative effect of higher pH and no inhibition effect of tert-butanol. The control for BrO3- formation was demonstrated and the reason for its control in the process of O3/SBC is the combined effect of SBC reductive properties, ozone exposure decrease and hydrogen peroxide concentration increase.

Characteristics of adsorbents made from biological, chemical and hybrid sludges and their effect on organics removal in wastewater treatment.

Meso-macropore adsorbents were prepared from biological sludge, chemical sludge and hybrid sludge of biological and chemical sludges, by chemically activating with 18.0 M H(2)SO(4) in the mass ratio of 1:3, and then pyrolyzing at 550 °C for 1 h in anoxic atmosphere. The physical and chemical characteristics of the sludge-based adsorbents were examined in terms of surface physical morphology, specific surface area and pore size distribution, aluminum and iron contents, surface functional groups and crystal structure. Furthermore, the adsorption effect of these adsorbents on the organic substances in wastewater was also investigated. The results indicated that the adsorption capacities of the sludge-based adsorbents for UV(254) were lower than that of commercial activated carbon (AC), whereas the adsorption capacities of the adsorbents prepared from hybrid sludge (HA) and chemical sludge (CA) for soluble COD(Cr) (SCOD(Cr)) were comparable or even higher than that of the commercial AC. The reasons might be that the HA and CA possessed well-developed mesopore and macropore structure, as well as abundant acidic surface functional groups. However, the lowest adsorption efficiency was observed for the biological sludge-based adsorbent, which might be due to the lowest metal content and overabundance of surface acidic functional groups in this adsorbent.