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1.
J Med Internet Res ; 23(9): e27098, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34491204

RESUMO

BACKGROUND: Hemodialysis (HD) therapy is an indispensable tool used in critical care management. Patients undergoing HD are at risk for intradialytic adverse events, ranging from muscle cramps to cardiac arrest. So far, there is no effective HD device-integrated algorithm to assist medical staff in response to these adverse events a step earlier during HD. OBJECTIVE: We aimed to develop machine learning algorithms to predict intradialytic adverse events in an unbiased manner. METHODS: Three-month dialysis and physiological time-series data were collected from all patients who underwent maintenance HD therapy at a tertiary care referral center. Dialysis data were collected automatically by HD devices, and physiological data were recorded by medical staff. Intradialytic adverse events were documented by medical staff according to patient complaints. Features extracted from the time series data sets by linear and differential analyses were used for machine learning to predict adverse events during HD. RESULTS: Time series dialysis data were collected during the 4-hour HD session in 108 patients who underwent maintenance HD therapy. There were a total of 4221 HD sessions, 406 of which involved at least one intradialytic adverse event. Models were built by classification algorithms and evaluated by four-fold cross-validation. The developed algorithm predicted overall intradialytic adverse events, with an area under the curve (AUC) of 0.83, sensitivity of 0.53, and specificity of 0.96. The algorithm also predicted muscle cramps, with an AUC of 0.85, and blood pressure elevation, with an AUC of 0.93. In addition, the model built based on ultrafiltration-unrelated features predicted all types of adverse events, with an AUC of 0.81, indicating that ultrafiltration-unrelated factors also contribute to the onset of adverse events. CONCLUSIONS: Our results demonstrated that algorithms combining linear and differential analyses with two-class classification machine learning can predict intradialytic adverse events in quasi-real time with high AUCs. Such a methodology implemented with local cloud computation and real-time optimization by personalized HD data could warn clinicians to take timely actions in advance.

2.
ESC Heart Fail ; 8(4): 3295-3307, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34151548

RESUMO

AIMS: Women with menopausal symptoms show evidence of accelerated epigenetic ageing, vascular aging and low-grade systemic inflammation status. However, data are limited regarding menopausal symptoms and risk of heart failure (HF). We aimed to explore the impact of menopausal symptoms on risk of HF. METHODS: We included 14 340 symptomatic menopausal women without a history of coronary heart disease (CHD) or HF from the Taiwan National Health Insurance Research Database as the experimental cohort. We included 14 340 asymptomatic women matched for age and comorbidities as controls. We surveyed possible comorbidity-attributable risks of HF and assessed whether menopausal symptoms play a role in risk of HF. Additional analyses were conducted to ascertain the association of CHD and HF in different risk factor burdens categories in both cohorts and CHD was applied as a sensitivity analysis. RESULTS: The incidence of HF was not significantly lower in the experimental than in the control cohort (4.87 vs. 5.06 per 1000 person-years, P = 0.336). Participants with a higher comorbidity burden had a proportionally increased risk of HF and CHD in both cohorts. The burden of risk factors had a greater impact on risk of HF in the control than in the experimental cohort (≥five risk factors, adjusted hazard ratio 25.69 vs. 14.75). Participants undergoing hormone therapy had no significant effect on the risk of HF, regardless of the presence or absence of menopausal symptoms. Subgroup analysis revealed that compared with the control cohort, the risk of HF in the experimental cohort did not increase significantly in all subgroups. CONCLUSIONS: Menopausal symptoms were associated with CHD risk but not with risk of HF. Traditional risk factors rather than menopausal symptoms play important roles in the HF risk among middle-aged women.

3.
J Proteome Res ; 20(5): 2953-2963, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33780252

RESUMO

Urothelial carcinoma (UC) is the ninth most prevalent malignancy worldwide. Noninvasive and efficient biomarkers with high accuracy are imperative for the surveillance and diagnosis of UC. CKD patients were enrolled as a control group in this study for the discovery of highly specific urinary protein markers of UC. An iTRAQ-labeled quantitative proteomic approach was used to discover novel potential markers. These markers were further validated with 501 samples by ELISA assay, and their diagnostic accuracies were compared to those of other reported UC markers. BRDT, CYBP, GARS, and HDGF were identified as novel urinary UC biomarkers with a high discrimination ability in a population comprising CKD and healthy subjects. The diagnostic values of the four novel UC markers were better than that of a panel of well-known or FDA-approved urinary protein markers CYFR21.1, Midkine, and NUMA1. Three of our discovered markers (BRDT, HDGF, GARS) and one well-known marker (CYFR21.1) were finally selected and combined as a marker panel having AUC values of 0.962 (95% CI, 0.94-0.98) and 0.860 (95% CI, 0.83-0.89) for the discrimination between UC and normal groups and UC and control (healthy + CKD) groups, respectively.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Biomarcadores , Biomarcadores Tumorais , Proteínas de Ciclo Celular , Humanos , Proteômica
4.
Medicine (Baltimore) ; 100(9): e25037, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655979

RESUMO

BACKGROUND: Traditional Chinese medicine (TCM) tongue diagnosis plays an important role in differentiation of symptoms because the tongue reflects the physiological and pathological condition of the body. The automatic tongue diagnosis system (ATDS), which noninvasively captures tongue images, can provide objective and reliable diagnostic information. Chronic kidney disease (CKD) currently is an important global public health problem and contributor to morbidity and mortality from non-communicable diseases. Thus, it is interesting to analyze and probe the relationship between tongue examination and CKD. METHODS: This protocol is a cross-sectional, case-controlled observational study investigating the usefulness of the ATDS in clinical practice by examining its efficacy as a diagnostic tool for CKD. Volunteers over 20 years old with and without CKD will be enrolled. Tongue images will be captured and the patients divided into 2 groups: CKD group and healthy group. Nine primary tongue features will be extracted and analyzed, including tongue shape, tongue color, tooth mark, tongue fissure, fur color, fur thickness, saliva, ecchymosis, and red dots. RESULT: The results of this study will systematically evaluate tongue manifestations of patients and examine its efficacy as an early detection and diagnosis of CKD. DISCUSSION: The aim of this protocol is to investigate discriminating tongue features to distinguish between CKD and normal people, and establish differentiating index to facilitate the noninvasive detection of CKD. TRIAL REGISTRIES: ClinicalTrials.gov; Identifier: NCT04708743.


Assuntos
Medicina Tradicional Chinesa/métodos , Insuficiência Renal Crônica/complicações , Doenças da Língua/diagnóstico , Língua/patologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Doenças da Língua/etiologia , Doenças da Língua/patologia , Adulto Jovem
5.
Chemosphere ; 273: 127834, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33077191

RESUMO

BACKGROUND: Di(2-ethylhexyl) phthalate (DEHP) is one of the most widely used phthalates and is associated with breast cancer. Ths association between DEHP and other types of cancer is not clear. DEHP may increase matrix metalloproteinase-9 that is critical for the development of urothelial cancer (UC). We examined the association between urinary phthalate metabolites and UC. CKD patients were selected as a control group because CKD patients are more at risk of UC than the general population. METHODS: In this cross-sectional study, we measured seven urinary phthalate metabolites that are abundant and can be measured using HPLC-MS/MS in Taiwan CKD patients between Jul 2013 and Dec 2015. MiBP (a urinary metabolite of Dibutyl phthalates[DBP]) and MEHHP (a urinary metabolite of DEHP) were described because they are the most abundant phthalate metabolites. The association of phthalate (log-transformed) and UC were analyzed using logistic regression with adjustments for age, gender, renal function, use of traditional Chinese medicine, toxins (dye, organic solvent), and non-steroidal anti-inflammatory drugs. RESULTS: We measured the urinary MEHHP and MiBP of 496 patients (224 UC and 272 CKD patients). The urinary MEHHP was associated with UC but MiBP was not. Medical history including the use of non-steroid anti-inflammatory drugs, exposure to environmental toxins (dye, paint, and organic solvent), and the use of traditional Chinese medicine was independently associated with UC. The adjusted odds ratio of MEHHP was 1.42 (95% confidence interval: 1.21-1.68). CONCLUSION: Phthalate urinary metabolite(MEHHP) may be associated with UC in CKD patients and the association is independent of well-known risk factors of UC.


Assuntos
Dietilexilftalato , Poluentes Ambientais , Neoplasias , Ácidos Ftálicos , Insuficiência Renal Crônica , Estudos Transversais , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Insuficiência Renal Crônica/induzido quimicamente , Taiwan , Espectrometria de Massas em Tandem
6.
Medicine (Baltimore) ; 99(50): e23629, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327340

RESUMO

BACKGROUND: Restless legs syndrome (RLS) is frequent in dialysis patients and occurs predominantly in its most severe forms. The aim of the present study was to evaluate the effects of electroacupuncture (EA) in hemodialysis patients with RLS by heart rate variability (HRV) monitor. METHODS: One hundred twelve subjects who were hemodialysis patients with RLS will be divided into 2 groups: experimental and control. Each subject will receive the treatment relevant to their group 2 times a week for 4 weeks. After 4 weeks of treatment the subject will enter a 2-week washout period, after which the subjects will switch groups. Measurements will include HRV recordings, International Restless Legs Syndrome Rating Scale (IRLSRS) and Insomnia Severity Index (ISI). RESULT: The results of this study will systematically evaluate the effectiveness and safety of electoracupuncture intervention for hemodialysis patients with RLS. DISCUSSION: This study is the first investigation to analyze the relationship between EA and the change of HRV by an objective monitor. If the findings of the current trial are positive, this study will also help support an effective, safe and cheap approach to clinical treatment of this challenging disorder, help foster improved understanding the relationship between autonomic nervous system and RLS, and ultimately contribute to elucidate the mechanisms of EA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04356794; registration date: April 22, 2020.


Assuntos
Eletroacupuntura/métodos , Diálise Renal/estatística & dados numéricos , Síndrome das Pernas Inquietas/epidemiologia , Síndrome das Pernas Inquietas/terapia , Adulto , Idoso , Eletroacupuntura/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Índice de Gravidade de Doença , Transtornos do Sono-Vigília/epidemiologia , Adulto Jovem
7.
Clin Sci (Lond) ; 134(13): 1593-1612, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32558891

RESUMO

Transcriptional co-activator with PDZ-binding motif (TAZ) is a key downstream effector of the Hippo tumor-suppressor pathway. The functions of TAZ in the kidney, especially in tubular epithelial cells, are not well-known. To elucidate the adaptive expression, protective effects on kidney injury, and signaling pathways of TAZ in response to acute kidney injury (AKI), we used in vitro (hypoxia-treated human renal proximal tubular epithelial cells [RPTECs]) and in vivo (mouse ischemia-reperfusion injury [IRI]) models of ischemic AKI. After ischemic AKI, TAZ was up-regulated in RPTECs and the renal cortex or tubules. Up-regulation of TAZ in RPTECs subjected to hypoxia was controlled by IκB kinase (IKK)/nuclear factor κ-light-chain-enhancer of activated B cell (NF-κB) signaling. TAZ overexpression attenuated hypoxic and oxidative injury, inhibited apoptosis and activation of p38 and c-Jun N-terminal kinase (JNK) proteins, and promoted wound healing in an RPTEC monolayer. However, TAZ knockdown aggravated hypoxic injury, apoptosis, and activation of p38 and JNK signaling, delayed wound closure of an RPTEC monolayer, and promoted G0/G1 phase cell-cycle arrest. Chloroquine and verteporfin treatment produced similar results to TAZ overexpression and knockdown in RPTECs, respectively. Compared with vehicle-treated mice, chloroquine treatment increased TAZ in the renal cortex and tubules, improved renal function, and attenuated tubular injury and tubular apoptosis after renal IRI, whereas TAZ siRNA and verteporfin decreased TAZ in the renal cortex and tubules, deteriorated renal failure and tubular injury, and aggravated tubular apoptosis. Our findings indicate the renoprotective role of tubular TAZ in ischemic AKI. Drugs augmenting (e.g., chloroquine) or suppressing (e.g., verteporfin) TAZ in the kidney might be beneficial or deleterious to patients with AKI.


Assuntos
Injúria Renal Aguda/metabolismo , Injúria Renal Aguda/prevenção & controle , Traumatismo por Reperfusão/complicações , Transativadores/metabolismo , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Animais , Apoptose , Células Epiteliais/citologia , Células Epiteliais/metabolismo , Feminino , Humanos , Túbulos Renais/citologia , Túbulos Renais/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/genética , NF-kappa B/metabolismo , Traumatismo por Reperfusão/metabolismo , Transdução de Sinais , Transativadores/genética
8.
Medicine (Baltimore) ; 99(18): e20072, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358388

RESUMO

Vertebral compression fractures (VCFs) are common in elderly and are treated with immobilization. Moreover, immobilization and old age may increase venous thromboembolism (VTE) risk. However, the incidence of VCFs-related VTE is unknown in elderly. The purposes of this study were to determine the incidence of VTE among VCF patients, to explore whether percutaneous vertebroplasty (PV) intervention may reduce VTE risk in VCFs patients.We conducted a population-based case-control study by using the National Health Insurance Research Database. We identified 1407 patients aged ≥65 with VCF who received PV and 1407 VCFs patients who did not receive PV after developing a 1:1 propensity score-matched study cohort and were followed up for 5 years. Using PV intervention as the exposure factor, a cause-specific Cox's proportional hazards model was used to examine the association between PV and VTE.After propensity score matching, the mean age of the study participants was 78 years and ∼23% of the analyzed participants were men, incidence of VTE in the PV and control cohorts was 5.77 and 4.19 per 1000 person-years, respectively. Both groups were nonsignificant difference after examination with different adjustment models. Patients with VCF and a history of heart failure, coronary artery disease, receiving antihypertension medication were at a significantly increased VTE risk.Elderly patients with VCF who received PV had a neutral impact on risk of VTE. VCF patients with heart failure, coronary artery disease, and receiving antihypertension medication were prone to developing VTE should be monitored cautiously.


Assuntos
Fraturas por Compressão/epidemiologia , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Tromboembolia Venosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Pontuação de Propensão , Fatores de Risco , Fatores Socioeconômicos , Taiwan/epidemiologia , Vertebroplastia/métodos
9.
PeerJ ; 7: e7964, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687279

RESUMO

Objective: To examine the long-term risk of stroke in women who have experienced symptomatic menopausal transition. Methods: In this nationwide, population-based cohort study conducted from January 1, 2000 to December 31, 2013, we identified 22,058 women with no prior history of stroke, who experienced symptomatic menopausal transition at ≥45 years of age. Moreover, 22,058 women without symptomatic menopause were matched by propensity scores and enrolled as a comparison group. The propensity score was calculated by using all characteristic variables of each subject, including demographics (age and monthly income), comorbidities (hypertension, hyperlipidemia, diabetes mellitus, obesity, chronic kidney disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, dysrhythmia, peripheral artery occlusive disease), Charlson's comorbidity index score, clinic visit frequency, and long-term medications (antihypertensives, antidiabetic agents, statins, antiplatelets, aspirin, warfarin, and hormone replacement therapy). The primary endpoint was the development of stroke after the onset of symptomatic menopausal transition. The Fine and Gray's proportional subhazards model was performed to assess the association between symptomatic menopausal transition and subsequent stroke. All subjects were followed up until December 31, 2013. Results: During a mean follow-up of 8.5 years (standard deviation 4.7 years, maximum 14 years), 2,274 (10.31%) women with symptomatic menopausal transition, and 1,184 (5.37%) matched comparison participants developed stroke. The incidence rates were 11.17 per 1,000 person-years in the symptomatic menopausal transition group compared with 8.57 per 1,000 person-years in the comparison group. The risk of developing stroke was significantly higher in women with symptomatic menopausal transition (crude subhazard ratio, 1.31; 95% confidence interval (CI) [1.22-1.41]; P < 0.001). After adjusting for demographics, comorbidities, clinic visit frequency, and long-term medications, the risk of stroke remained statistically significant (adjusted subhazard ratio, 1.30; 95% CI [1.21-1.40]; P < 0.001). Moreover, subgroup analyses revealed no evidence for inconsistent effects for symptomatic menopausal transition on subsequent risk of stroke across all subgroups except age, comorbidities, hypertension, and use of antihypertensives. Women with early menopausal transition (before age 50), without comorbid condition, without hypertension, or without use of antihypertensives are at a higher risk of stroke. The longer duration of symptomatic menopausal transition was associated with higher risk of stroke (P for trend < 0.001). Conclusion: In this large-scale retrospective cohort study, symptomatic menopausal transition was statistically significantly associated with a 30% increased risk of stroke. Further prospective studies are required to confirm our findings.

11.
BMC Nephrol ; 20(1): 391, 2019 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660901

RESUMO

INTRODUCTION: Cell-free deoxyribonucleic acid DNA (cf-DNA) in urine is promising due to the advantage of urine as an easily obtained and non-invasive sample source over tissue and blood. In clinical practice, it is important to identify non-invasive biomarkers of chronic kidney disease (CKD) in monitoring and surveillance of disease progression. Information is limited, however, regarding the relationship between urine and plasma cf-DNA and the renal outcome in CKD patients. METHODS: One hundred and thirty-one CKD patients were enrolled between January 2016 and September 2018. Baseline urine and plasma cell-free mitochondrial DNA (cf-mtDNA) and cell-free nuclear DNA (cf-nDNA) were isolated using quantitative real-time PCR. Estimated glomerular filtration rate (eGFR) measurement was performed at baseline and 6-month follow-up. Favorable renal outcome was defined as eGFR at 6 months minus baseline eGFR> = 0. Receiver operator characteristics (ROC) curve analysis was performed to assess different samples of cf-DNA to predict favorable renal outcomes at 6 months. A multivariate linear regression model was used to evaluate independent associations between possible predictors and different samples of cf-DNA. RESULTS: Patients with an advanced stage of CKD has significantly low plasma cf-nDNA and high plasma neutrophil gelatinase-associated lipocalin (NGAL) levels. Low urine cf-mtDNA, cf-nDNA levels and low plasma NGAL were significantly correlated with favorable renal outcomes at 6 months. The urine albumin-creatinine ratio (ACR) or urine protein-creatinine ratio (PCR) level is a robust predictor of cf-mtDNA and cf-nDNA in CKD patients. Baseline urine levels of cf-mtDNA and cf-nDNA could predict renal outcomes at 6 months. CONCLUSIONS: Urinary cf-mtDNA and cf-nDNA may provide novel prognostic biomarkers for renal outcome in CKD patients. The levels of plasma cf-nDNA and plasma NGAL are significantly correlated with the severity of CKD.


Assuntos
Ácidos Nucleicos Livres/urina , DNA Mitocondrial/urina , Insuficiência Renal Crônica/fisiopatologia , Adulto , Idoso , Albuminúria/urina , Área Sob a Curva , Biomarcadores/sangue , Biomarcadores/urina , Ácidos Nucleicos Livres/sangue , Creatinina/urina , DNA Mitocondrial/sangue , Progressão da Doença , Feminino , Taxa de Filtração Glomerular , Humanos , Lipocalina-2/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC
12.
Sci Rep ; 9(1): 3473, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30837585

RESUMO

Urothelial cancer (UC) is a common kidney cancer in Taiwan and patients with chronic kidney disease (CKD) are more at risk for UC than the general population. The diagnostic value of urine analysis and urine cytology is limited, especially in CKD patients. The aim of the study is to develop a nomogram to predict the risk of UC in CKD patients. We enrolled 169 UC patients and 1383 CKD patients from 9 hospitals in Taiwan between 2012 and 2015. CA125, HE4, clinical characteristics, and medical history were analyzed using multivariable logistic regression for its association with UC. A nomogram was developed to predict the risk of UC and was validated using Bootstrap. CA125 was associated with UC in CKD patients (OR: 5.91, 95% CI: 3.24-10.77) but HE4 was not (OR: 1.29, 95% CI: 0.67-2.35). A nomogram based on patients' age, estimated glomerular filtration rate, CA125 (log transformed), smoking, exposure of environmental toxin, use of nonsteroid anti-inflammatory drugs, and use of traditional Chinese medicine was conducted. The AUC of the nomogram was 0.90 (95% CI: 0.86-0.92, p < 0.01). Serum CA125 may identify UC patients from CKD patients but has limited diagnostic value due to low sensitivity. The diagnostic value of serum CA125 level can be improved by the combination with clinical characteristics including age, renal function, and medical history.


Assuntos
Suscetibilidade a Doenças , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Neoplasias Urológicas/epidemiologia , Neoplasias Urológicas/etiologia , Idoso , Biomarcadores , Exposição Ambiental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Razão de Chances , Insuficiência Renal Crônica/diagnóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia , Neoplasias Urológicas/diagnóstico
13.
PLoS One ; 14(1): e0210656, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30633770

RESUMO

Angiotensin-converting enzyme (ACE) is the primary enzyme that converts angiotensin I (Ang I) to angiotensin II (Ang II) in the renin-angiotensin system (RAS). However, chymase hydrates Ang I to Ang II independently of ACE in some kidney diseases, and it may play an important role. The present study investigated whether chymase played a crucial role in aristolochic acid I (AAI)-induced nephropathy. C57BL/6 mice were treated with AAI via intraperitoneal injection for an accumulated AAI dosage of 45 mg/kg body weight (BW) (15 mg/kg BW per day for 3 days). The animals were sacrificed after acute kidney injury development, and blood, urine and kidneys were harvested for biochemical and molecular assays. Mice exhibited increased serum creatinine, BUN and urinary protein after the AAI challenge. Significant infiltrating inflammatory cells and tubular atrophy were observed in the kidneys, and high immunocytokine levels were detected. Renal RAS-related enzyme activities were measured, and a significantly increased chymase activity and slightly decreased ACE activity were observed in the AAI-treated mice. The renal Ang II level reflected the altered profile of RAS enzymes and was significantly increased in AAI-treated mice. Treatment of AAI-induced nephropathic mice with an ACE inhibitor (ACEI) or chymase inhibitor (CI; chymostatin) reduced renal Ang II levels. The combination of ACEI and CI (ACEI+CI) treatment significantly reversed the AAI-induced changes of Ang II levels and kidney inflammation and injuries. AAI treatment significantly increased renal p-MEK without increasing p-STAT3 and p-Smad3 levels, and p-MEK/p-ERK1/2 signalling pathway was significantly activated. CI and ACEI+CI treatments reduced this AAI-activated signaling pathway. AAI-induced nephropathy progression was significantly mitigated with CI and ACEI+CI treatment. This study elucidates the role of RAS in the pathogenesis of AAI-induced nephropathy.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/metabolismo , Angiotensina II/metabolismo , Ácidos Aristolóquicos/toxicidade , Quimases/metabolismo , Rim/metabolismo , Animais , Feminino , Rim/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Transdução de Sinais/fisiologia
14.
Nephrology (Carlton) ; 24(9): 896-903, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30334303

RESUMO

AIM: Recombinant tissue plasminogen activator (rt-PA) administration is the most prevalent treatment for acute ischemic within golden time. However, the effects of rt-PA on the kidney function in such patients remain unknown. This study determined long-term renal outcomes in patients with acute ischemic stroke receiving systemic rt-PA. METHODS: We enroled patients who were hospitalized for acute ischemic stroke from January 2001 to January 2017. We applied 1:2 propensity score matching to eliminate various confounding variables. We defined surrogate renal outcomes as declining of estimated glomerular filtration rate (eGFR) greater than 30% and 50%, and chronic kidney disease (CKD) with eGFR less than 60 mL/min. We then compared the 1-year eGFR with paired t-test in patients treated with or without rt-PA. RESULTS: Overall, 343 of 1739 patients received rt-PA within golden time. After 1:2 propensity score matching, their baseline characteristics were grouped as treated with rt-PA (n = 235) or not (n = 394). rt-PA-treated patients exhibited slower renal progression, including the risk of eGFR declining greater than 30% (hazard ratio (HR), 0.72; P = 0.03), risk of declining eGFR greater than 50% (HR, 0.63; P = 0.046) and risk of CKD (HR, 0.61; P = 0.005). After 1-year cohort, the rt-PA group exhibited an improved renal outcome by the paired t-test (propensity match: ΔGFR = 9.1 (95% confidence interval: 6.3, 11.8), P < 0.001 in rt-PA group; ΔGFR = -1.1 (95% confidence interval: -2.9, 0.7), P = 0.23 in non-rt-PA group). In patients with eGFR less than 45 mL/min (n = 34), intracerebral haemorrhage was not reported. CONCLUSION: Patients receiving rt-PA for acute ischemic stroke exhibit favourable renal outcomes, and no increased incidence of intracerebral haemorrhage occurs in rt-PA patients with advanced CKD.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Encéfalo/efeitos dos fármacos , Fibrinolíticos/administração & dosagem , Rim/efeitos dos fármacos , Insuficiência Renal Crônica/fisiopatologia , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Encéfalo/fisiopatologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/efeitos adversos , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
15.
Nephrol Dial Transplant ; 34(8): 1354-1360, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29939300

RESUMO

BACKGROUND: Numerous studies have shown that exposure to air pollution, especially particulate matter (PM) with a diameter <2.5 µm (PM2.5), was associated with various diseases. We tried to determine the impact of PM2.5 and other weather factors on acute lung edema in patients with Stage 5 nondialysis chronic kidney disease (CKD Stage 5-ND). METHODS: In total, 317 CKD Stage 5-ND (estimated glomerular filtration rate 6.79 ± 4.56 mL/min) patients residing in central Taiwan who developed acute lung edema and initiated long-term dialysis were included in this case-crossover study. Pearson's correlation test was used to examine the relationship of acute lung edema cases with PM2.5 levels and ambient temperature separately. RESULTS: The average PM2.5 level within the 7-day period correlated with acute lung edema incidence in the fall [adjusted odds ratio (OR) 3.23, P = 0.047] and winter (adjusted OR 1.99, P < 0.001). In winter, even a 3-day exposure to PM2.5 was associated with increased risk (adjusted OR 1.55, P < 0.001). The average temperatures within 3 days in spring and summer were correlated positively with the risk (adjusted OR 2.77 P < 0.001 and adjusted OR 2.72, P < 0.001, respectively). In the fall and winter, temperatures were correlated negatively with the risk (adjusted OR 0.36, P < 0.001 and adjusted OR 0.54, P < 0.001, respectively). CONCLUSIONS: A high PM2.5 level was associated with an increased risk of acute lung edema. High ambient temperature in hot seasons and low ambient temperature in cold seasons were also associated with increased risk. It is essential to educate these patients to avoid areas with severe air pollution and extreme ambient temperature.


Assuntos
Poluição do Ar , Exposição Ambiental/efeitos adversos , Falência Renal Crônica/complicações , Material Particulado , Edema Pulmonar/induzido quimicamente , Idoso , Poluentes Atmosféricos , Estudos Cross-Over , Feminino , Taxa de Filtração Glomerular , Temperatura Alta , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Edema Pulmonar/complicações , Risco , Estações do Ano , Taiwan
16.
Free Radic Res ; 52(11-12): 1456-1463, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572748

RESUMO

To find the associations of circulating cyclophilin A (CyP A) and CD147/EMMPRIN with renal outcomes in type 2 diabetes patients and possible pathogenesis involved. Total 131 patients were recruited since 2004. Glycated hemoglobin, blood glucose and urine albumin-creatinine ratio levels at baseline and every 3 months were measured. Plasma CyP A and CD147 were also measured at baseline. Patients were divided into two groups based upon the median level of the baseline plasma CyP A value: < 93.64 ng/mL (group A, n = 65), ≥ 93.64 ng/mL (group B, n = 66). The estimated glomerular filtration rate was calculated at each follow-up visit. Besides, mitochondrial function assay by cellular mitochondrial energy utility was studied when cells were exposed to glucose or exogenous CyP A or both. Multivariate analysis, using median level (93.64) ng/mL as the cut-off value, revealed that circulating CyP A and CD147 levels at baseline were associated with the baseline estimated glomerular filtration rate (eGFR) (p = .042 and p = .001 separately) in cross-sectional analysis. Longitudinally, higher baseline plasma CyP A level was also correlated to a rapid decline in eGFR (p = .016). The results were also significant when using the continuous plasma CyP A level (p = .003). In cells exposed to glucose, results of oxygen consumption rate (OCR) showed a significant reduction in basal respiration, maximal respiration and ATP production. Depressed OCR further occurred when incubated with both of CyP A and glucose. Plasma CyP A and CD147 can serve as indicators of renal disease progression in type 2 diabetes patients.


Assuntos
Basigina/sangue , Ciclofilina A/sangue , Diabetes Mellitus Tipo 2/sangue , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/patologia , Progressão da Doença , Idoso , Animais , Glicemia/análise , Células Cultivadas , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/metabolismo , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/metabolismo , Feminino , Humanos , Estudos Longitudinais , Masculino , Camundongos , Camundongos Transgênicos , Mitocôndrias/metabolismo
17.
Ther Clin Risk Manag ; 14: 1923-1931, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30349271

RESUMO

Purpose: It has been shown that the power spectral density (PSD) of heart rate variability (HRV) can be decomposed into a power-law function and a residual PSD (rPSD) with a more prominent high-frequency component than that in traditional PSD. This study investigated whether the residual HRV (rHRV) measures can better discriminate patients with acute myocardial infarction (AMI) from patients with patent coronary artery (PCA) than traditional HRV measures. Materials and methods: The rHRV and HRV measures of 48 patients with AMI and 69 patients with PCA were compared. Results: The high-frequency power of rHRV spectrum was significantly enhanced while the low-frequency and very low-frequency powers of rHRV spectrum were significantly suppressed, as compared to their corresponding traditional HRV spectrum in both groups of patients. The normalized residual high-frequency power (nrHFP = residual high-frequency power/residual total power) was significantly greater than the corresponding normalized high-frequency power in both groups of patients. Between-groups comparison showed that the nrHFP in AMI patients was significantly smaller than that in PCA patients. Receiver operating characteristic curve analysis showed that the nrHFP or nrHFP + normalized residual very low-frequency power (residual very low-frequency power/rTP) had better discrimination capability than the corresponding HRV measures for predicting AMI. Conclusions: Compared with traditional HRV measures, the rHRV measures can slightly better differentiate AMI patients from PCA patients, especially the nrHFP or nrHFP + normalized residual very low-frequency power.

18.
PLoS One ; 13(10): e0206036, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30335825

RESUMO

OBJECTIVE: To assess the relationship between coronary heart disease (CHD) and menopausal symptoms in middle-aged women in Taiwan. PATIENTS AND METHODS: The present study identified 14,340 symptomatic menopausal women without a history of CHD from the Taiwan National Health Insurance Research Database from January 1, 2000, to December 31, 2013. A total of 14,340 age- and Charlson-comorbidity-index-score-matched asymptomatic women were used as controls. Possible comorbidity-attributable risks of CHD were surveyed to assess whether the symptomatic menopausal cohort had a higher incidence of CHD. RESULTS: The incidence of CHD was higher in the symptomatic menopausal cohort than in the control cohort (17.18 vs. 12.05 per 1000 person-years). After adjustment in multivariate Cox analysis, the risk of CHD was significantly higher in the symptomatic menopausal cohort (adjusted hazard ratio = 1.344, 95% confidence interval [CI] = 1.262-1.43, P < 0.001) than in the control cohort. In the symptomatic menopausal cohort, the risk of CHD was significantly higher in all subgroups, except for the hormone therapy (HT) subgroup. Patients undergoing HT had a nonsignificantly higher risk of CHD, regardless of the presence or absence of menopausal symptoms. CONCLUSION: This large-scale longitudinal retrospective cohort study revealed that menopausal symptoms are an independent risk factor for CHD. Moreover, our findings indicate that HT has a nonsignificant effect on the risk of CHD.


Assuntos
Doença das Coronárias/epidemiologia , Menopausa/fisiologia , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Terapia de Reposição Hormonal , Humanos , Incidência , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologia
19.
Mayo Clin Proc ; 93(10): 1474-1483, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30286832

RESUMO

OBJECTIVE: To investigate the association between statin use and mortality in patients with dialysis-requiring acute kidney injury (AKI-D). PATIENTS AND METHODS: This nationwide, population-based, retrospective cohort study included 6091 hospitalized patients with AKI-D (1271 statin users and 4820 statin nonusers) retrieved from the National Health Insurance Research Database of Taiwan between January 1, 2000, and December 31, 2012. All the patients were followed up until December 31, 2013. Primary and secondary outcomes were 1-year and in-hospital mortality, respectively. All the primary analyses were performed using the intention-to-treat approach. RESULTS: During 1-year follow-up, 492 of 1271 statin users (38.7%) and 2365 of 4820 statin nonusers (49.1%) died. After propensity score matching, statin use was independently associated with lower risks of 1-year all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.69-0.9; P<.001) and in-hospital all-cause mortality (HR, 0.84; 95% CI, 0.71-0.99; P=.04). The survival benefit of statin treatment was dose-dependent and consistent across subgroups based on sensitivity analyses. CONCLUSION: Statin use was independently associated with reduced risks of 1-year and in-hospital mortality in patients with AKI-D. Statin therapy may be beneficial in this patient group. However, further clinical trials should be performed to confirm the findings.


Assuntos
Injúria Renal Aguda , Inibidores de Hidroximetilglutaril-CoA Redutases , Hiperlipidemias , Diálise Renal , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/terapia , Idoso , Causas de Morte , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperlipidemias/tratamento farmacológico , Hiperlipidemias/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Vigilância da População , Diálise Renal/métodos , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida , Taiwan/epidemiologia
20.
PLoS One ; 13(10): e0205502, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325958

RESUMO

AIM: Diabetes is a complex metabolic disease characterized by chronic low-grade inflammation in which genetic and environmental factors are involved. Growing evidence implicates that alterations of the gut microbiota potentially contribute to the emergence of metabolic diseases. The human appendix has more recently been recognized as a microbial reservoir for repopulating the gastrointestinal tract and an important part of the immune system. Thus, appendectomy may influence microbial ecology and immune function. This study investigated the association between appendectomy and type 2 diabetes risk. METHODS: We analyzed a cohort of 10954 patients who underwent appendectomy between 1998 and 2013 based on the Taiwan National Health Insurance Program database. A comparison cohort of 43815 persons without appendectomy was selected randomly and matched by sex, age, comorbidities, and index year. To ensure reliability of the results, a sensitivity analysis using a propensity score-matched study was performed. We observed the subsequent development of type 2 diabetes in both cohorts. RESULTS: Although the overall incidence of type 2 diabetes in the appendectomy patients was 7.9% higher than that in the non-appendectomy patients, it was not statistically significant (95% confidence interval [CI], 0.997-1.168) after the adjustment of confounding factors. Multivariate regression analysis revealed that the adjusted hazard ratio (HR) of type 2 diabetes was 1.347 for appendectomy patients < 30 years of age (95% CI, 1.009-1.798) compared to non-appendectomy patients. The incidence of type 2 diabetes was higher within 3 years of post-appendectomy follow-up than for non-appendectomy patients (HR, 2.017; 95% CI, 1.07-3.802). Age impacted the association between appendectomy and type 2 diabetes risk (Pinteraction = 0.002); in contrast, sex did not affect the association between appendectomy and type 2 diabetes risk (Pinteraction = 0.88). CONCLUSIONS: Our study results suggest that appendectomy increases type 2 diabetes risk, particularly when performed prior to middle age.


Assuntos
Apendicectomia , Diabetes Mellitus Tipo 2/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taiwan , Adulto Jovem
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