UV-Vis quantification of the iron content in iteratively steam and HCl purified single-walled carbon nanotubes.

As-produced carbon nanotubes contain impurities which can dominate the properties of the material and are thus undesired. Herein we present a multi-step purification treatment that combines the use of steam and hydrochloric acid in an iterative manner. This allows the reduction of the iron content down to 0.2 wt. % in samples of single-walled carbon nanotubes (SWCNTs). Remarkably, Raman spectroscopy analysis reveals that this purification strategy does not introduce structural defects into the SWCNTs' backbone. To complete the study, we also report on a simplified approach for the quantitative assessment of iron using UV-Vis spectroscopy. The amount of metal in SWCNTs is assessed by dissolving in HCl the residue obtained after the complete combustion of the sample. This leads to the creation of hexaaquairon(III) chloride which allows the determination of the amount of iron, from the catalyst, by UV-Vis spectroscopy. The main advantage of the proposed strategy is that it does not require the use of additional complexing agents.

How to Personalize General Anesthesia-A Prospective Theoretical Approach to Conformational Changes of Halogenated Anesthetics in Fire Smoke Poisoning.

Smoke intoxication is a central event in mass burn incidents, and toxic smoke acts at different levels of the body, blocking breathing and oxygenation. The majority of these patients require early induction of anesthesia to preserve vital functions. We studied the influence of hemoglobin (HMG) and myoglobin (MGB) blockade by hydrochloric acid (HCl) in an interaction model with gaseous anesthetics using molecular docking techniques. In the next part of the study, molecular dynamics (MD) simulations were performed on the top-scoring ligand-receptor complexes to investigate the stability of the ligand-receptor complexes and the interactions between ligands and receptors in more detail. Through docking analysis, we observed that hemoglobin creates more stable complexes with anesthetic gases than myoglobin. Intoxication with gaseous hydrochloric acid produces conformational and binding energy changes of anesthetic gases to the substrate (both the pathway and the binding site), the most significant being recorded in the case of desflurane and sevoflurane, while for halothane and isoflurane, they remain unchanged. According to our theoretical model, the selection of anesthetic agents for patients affected by fire smoke containing hydrochloric acid is critical to ensure optimal anesthetic effects. In this regard, our model suggests that halothane and isoflurane are the most suitable choices for predicting the anesthetic effects in such patients when compared to sevoflurane and desflurane.

Dispersion of acid without gastric perforation on ingestion of toilet cleaner: a rare autopsy case.

Toilet cleaner containing hydrochloric acid is a common item found in households all over the world. Due to the availability of the substance, it becomes one of the main contributors to corrosive damage to the gastrointestinal system. This study reports a case of a female in her 50s with an alleged history of ingestion of toilet cleaner an empty bottle of which was found together with a suicide note at the incident site. During the autopsy, the forensic expert made an intriguing observation regarding the dispersion of ingested acid to other organs without gastric perforation. Despite the absence of gastric perforation, the corrosive effects of the ingested acid were evident in various organs, including the liver and spleen. This phenomenon suggests a unique mechanism by which the acid is able to disperse and cause damage beyond the stomach, leading to widespread organ involvement. However, through a comprehensive analysis of the detailed history, typical macroscopic autopsy findings, and chemical analysis reports, it is possible to establish that the cause of death is corrosive acid poisoning. In such cases, further investigation is warranted to gain a better understanding of the underlying mechanisms responsible for the dispersion of the acid and its clinical implications. By delving deeper into these aspects, we can enhance our knowledge and contribute to the field of forensic medicine.

The relevant effect of marine salt and epiphytes on Posidonia oceanica waste pyrolysis: Removal of SO2/HCl emissions and promotion of O/HCOOH formation.

Significant quantities of Posidonia oceanica deposit on some beaches and coastlines every year, which generates high costs associated with the disposal of this waste. Pyrolysis may be an adequate way for its valorization. However, it would imply to know how the process takes place and if the removal of its natural detrital inorganic matter (epiphytes, marine salt and sand) is necessary, which are the objectives of this research. Pyrolysis by thermogravimetry-mass spectrometry was carried out on both the washed and unwashed samples. During this waste pyrolysis, the following occurs: (i) the high alkali metal chloride content promotes fragmentation reactions of carbohydrates and O formation, which increases HCOOH intensities at temperatures between 250 and 360 °C; (ii) from 500 °C to 650 °C, Fe2O3 and decomposition of carbonates seem to be involved in reactions that produce O release and steam and CO2 reforming of hydrocarbons and oxygenated organic compounds with H2 generation; (iii) from 650 °C to 750 °C, Fe2O3, high alkali metal content and carbonate decomposition generate char gasification, an increase in O release, SO2 capture and HCOOH formation. In general, the abundance of inorganic matter (chlorides, carbonates, etc.) minimizes the release of various compounds during pyrolysis, including SO2 and HCl, while increasing HCOOH production. Thus, this high content of inorganic matter may represent an advantage for its pyrolysis, producing value-added chemical products with a reduced environmental impact. Therefore, this study may be the starting point for defining the optimal pyrolysis conditions for this waste valorisation.

Zwitterion modified chitosan as a high-performance corrosion inhibitor for mild steel in hydrochloric acid solution.

Herein, a novel chitosan Schiff base (CS-FGA) as a sustainable corrosion inhibitor has been successfully synthesized via a simple amidation reaction by using an imidazolium zwitterion and chitosan (CS). The corrosion inhibition property of CS-FGA for mild steel (MS) in a 1.0 M HCl solution was studied by various electrochemical tests and physical characterization methods. The findings indicate that the maximum inhibition efficiency of CS-FGA as a mixed-type inhibitor for MS in 1.0 M HCl solution with 400 mg L-1 reaches 97.6 %, much much higher than the CS and the recently reported chitosan-based inhibitors. Scanning electron microscopy (SEM), atomic force microscopy (AFM), and water contact angle (WCA) results reveal that the CS-FGA molecules firmly adsorb on the MS surface to form a protective layer. The adsorption of CS-FGA on the MS surface belongs to the Langmuir adsorption isotherm containing both the physisorption and chemisorption. According to the X-ray photoelectron spectroscopy (XPS) and UV-vis spectrum, FeN bonds presented on the MS surface further prove the chemisorption between CS-FGA and Fe to generate the stable protective layer. Additionally, theoretical calculations from quantum chemical calculation (DFT) and molecular simulations (MD) were performed to reveal the inhibition mechanism of CS-FGA.

Fluorine contamination, mobility, and risks in soils at a phosphate-gypsum waste landfill: a new analytical method and comparison with previous methods.

This study used a new X-ray fluorescence (XRF)-based analytical method with better precision and sensitivity to evaluate the fluorine concentrations in soil. It was hypothesized that the XRF method with a pellet-synthesizing procedure may effectively analyze the fluorine concentrations in soil with ease and reliability. The total fluorine concentrations determined using XRF were compared with those determined using three different types of analytical protocols-incineration/distillation, alkaline fusion, and aqua regia extraction procedures. Among the three procedures, the incineration/distillation procedure did not show reliable precision and reproducibility. In contrast, the total fluorine concentrations determined using the XRF analysis were linearly correlated with those determined using the alkaline fusion and aqua regia extraction procedures. Based on the results of the Korean waste leaching procedure and toxicity characteristics leaching procedure, the leachability of fluorine from soil and waste was not directly related to total fluorine concentrations in soil. Risk assessment also revealed that the fluorine-rich soils did not show non-carcinogenic toxic effects, despite exceeding the regulation level (800 mg/kg) in South Korea for total fluorine concentrations in soil. Our results suggest that XRF analysis in combination with the newly developed pretreatment method may be a promising alternative procedure for easily and rapidly determining the total fluorine concentration in soil. However, further efforts are needed to evaluate fluorine leachability and its associated risks in fluorine-contaminated soils.

Unlocking high-performance HCl adsorption at elevated temperatures: the synthesis and characterization of robust Ca-Mg-Al mixed oxides.

The presence of HCl and SO2 gas imposes limitations on syngas utilization obtained from household waste in a wide range of applications. The hydrotalcite-like compounds (HTLs) have been proved that could remove HCl efficiency. However, the research on impact of synthesis conditions of HTLs and SO2 on HCl removal was limited. In this study, a range of Ca-Mg-Al mixed oxide sorbents was synthesized by calcining HTLs, with variations in crystallization temperature, solution pH, and the Ca/Mg molar ratio. These sorbents were examined for their effectiveness in removing HCl at medium-high temperatures under diverse conditions. The adsorption performance of selected sorbents for the removal of HCl, SO2, and HCl-SO2 mixed gas at temperature of 350 °C, 450 °C, and 550 °C, respectively, was evaluated using thermogravimetric analysis (TGA). It was observed that the HTL synthesis parameters significantly influenced the HCl adsorption capacity of Ca-Mg-Al mixed oxides. Notably, HTLs synthesized at 60 °C, a solution pH of 10-11, and a Ca/Mg ratio of 4 exhibited superior crystallinity and optimal adsorption characteristics. For individual HCl and SO2 removal, temperature had a minor effect on HCl adsorption but significantly impacted SO2 adsorption rates. At temperatures above 550 °C, SO2 removal efficiency substantially decreased. When exposed to a mixed gas, the Ca-Mg-Al mixed oxides could efficiently remove both HCl and SO2 at temperatures below 550 °C, with HCl dominating the adsorption process at higher temperatures. This dual-action capability is attributed to several mechanisms through which HTL sorbents interacted with HCl, including pore filling, ion exchange, and cation exchange. Initially, HCl absorbed onto specific sites created by water and CO2 removal due to the surface's polarity. Subsequently, HCl reacted with CaCO3 and CaO formed during HTL decomposition.

Differential mRNA profiles reveal the potential roles of genes involved in lactate stimulation in mouse macrophages.

Lactate is a glycolysis end product, and its levels are markedly associated with disease severity, morbidity, and mortality in sepsis. It modulates key functions of immune cells, including macrophages. In this investigation, transcriptomic analysis was performed using lactic acid, sodium lactate, and hydrochloric acid-stimulated mouse bone marrow-derived macrophages (iBMDM), respectively, to identify lactate-associated signaling pathways. After 24 h of stimulation, 896 differentially expressed genes (DEG) indicated were up-regulation, whereas 792 were down-regulated in the lactic acid group, in the sodium lactate group, 128 DEG were up-regulated, and 41 were down-regulated, and in the hydrochloric acid group, 499 DEG were up-regulated, and 285 were down-regulated. Subsequently, clinical samples were used to further verify the eight genes with significant differences, among which Tssk6, Ypel4, Elovl3, Trp53inp1, and Cfp were differentially expressed in patients with high lactic acid, indicating their possible involvement in lactic acid-induced inflammation and various physiological diseases caused by sepsis. However, elongation of very long chain fatty acids protein 3 (Elovl3) was negatively correlated with lactic acid content in patients. The results of this study provide a necessary reference for better understanding the transcriptomic changes caused by lactic acid and explain the potential role of high lactic acid in the regulation of macrophages in sepsis.

Comparative study on composition and functional properties of brewer's spent grain proteins precipitated by citric acid and hydrochloric acid.

Brewer's spent grain (BSG) is an abundant agro-industrial residue and a sustainable low-cost source for extracting proteins. The composition and functionality of BSG protein concentrates are affected by extraction conditions. This study examined the use of citric acid (CA) and HCl to precipitate BSG proteins. The resultant protein concentrates were compared in terms of their composition and functional properties. The BSG protein concentrate precipitated by CA had 10% lower protein content, 5.8% higher carbohydrate, and 5.4% higher lipid content than the sample precipitated by HCl. Hydrophilic/hydrophobic protein and saturated/unsaturated fatty acid ratios increased by 16.9% and 26.5% respectively, in the sample precipitated by CA. The formation of CA-cross-linkages was verified using shotgun proteomics and Fourier transform infrared spectroscopy. Precipitation by CA adversely affected protein solubility and emulsifying properties, while improving foaming properties. This study provides insights into the role of precipitants in modulating the properties of protein concentrates.

Hydrochloric Acid-Induced Acute Lung Injury Models: Dynamic Change and Quantitative Analysis of Modified Lung Ultrasound Scoring System and High-Resolution Computed Tomography.

OBJECTIVE: Acute lung injury (ALI) has become a research hotspot due to its significant public health impact. To explore the value of the use of modified lung ultrasound (MLUS) scoring system for evaluating ALI using a rabbit model of ALI induced by hydrochloric acid (HCl) and investigate its correlation with high-resolution computed tomography (HRCT) and histopathological scores. METHODS: Twenty New Zealand laboratory rabbits were randomly assigned to control group (N = 5) and 3 experimental groups (N = 5 each). The control group received instillation of physiological saline, while the 3 experimental groups received 2 mL/kg of different doses of HCl instillation (mild group: pH 1.5, moderate group: pH 1.2, and severe group: pH 1.0) through the trachea under ultrasound guidance. Pulmonary ultrasound (using Mindray Reason9 linear array probes with frequency of 6-15 mHz) and HRCT examinations were performed before modeling (0H) and at 1H, 2H, 4H, 8H, 12H after modeling. The experimental rabbits were sacrificed at 12H for examination of gross lung morphology and hematoxylin-eosin-stained histopathological sections. The correlation of MLUS scores with HRCT/histopathological scores was assessed. RESULTS: All rabbits in the experimental groups showed oxygenation index PaO2/FiO2<300. Successful establishment of ALI model was proven by autopsy (successful modeling rate: 100%). The pathological damage increased with increase in HCl dosage. MLUS scores showed a positive correlation with HRCT scores/pathological severity. There was a strong positive correlation between MLUS scores and histopathological scores (r = 0.963, p < 0.05) as well as between HRCT scores and histopathological scores (r = 0.932, p < 0.05). CONCLUSION: Transtracheal injection of different dosages of HCl under ultrasound guidance induced different degrees of ALI. The MLUS scoring system can be used for semiquantitative evaluation of ALI, and is suitable as a screening tool.

An Alternative Procedure for a Win-win African-Swiss Cooperation in Gold Production in Africa.

The growth of Africa as a major gold (Au) exporter can not only strengthen economic ties with other parts of the world, but also lead to solutions to global industrial challenges, and the only way to stop gold smuggling out of gold-producing African countries seems to be having multiple refineries in Africa, for which developing gold-producing African countries might need technological assistance provided by a more developed country, especially Switzerland. In this Note, the chemistry of gold mining was discussed, and the idea is conveyed that if aqua regia is used as a main reagent in both gold mining and the electrolytic refinement of gold, then the two systems of gold mining and gold refining can be coupled industrially and geographically, and such a coupling can facilitate the growth of home-grown gold refineries in gold-producing African countries. It is also discussed that with Swiss companies finding it economical to properly use aqua regia in Africa as described, a win-win African-Swiss cooperation will be established that will benefit both the Swiss companies and gold-producing African countries. Further, it is concluded that the addressed cooperation will be accompanied by four of the seventeen goals called 'Sustainable Development Goals' by the United Nations.

Comparative study on liquid versus gas phase hydrochloric acid hydrolysis for microcrystalline cellulose isolation from sugarcane bagasse.

Microcrystalline cellulose (MCC) was successfully synthesized from sugarcane bagasse using a rapid, low-temperature hydrochloric acid (HCl) gas treatment. The primary aim was to develop an energy-efficient "green" cellulose extraction process. Response surface methodology optimized the liquid-phase hydrolysis conditions to 3.3 % HCl at 117 °C for 127 min to obtain MCC with 350 degree of polymerization. An alternative gas-phase approach utilizing gaseous HCl diluted in hot 40 °C air was proposed to accelerate MCC production. The cellulose pulp was moistened to 15-18 % moisture content and then exposed to HCl gas, which was absorbed by the moisture in the cellulose fibers to generate a highly concentrated acidic solution that hydrolyzed the cellulose. The cellulose pulp was isolated from depithed bagasse through soda pulping, multistage bleaching and cold alkali purification. Hydrolysis was conducted by saturating the moist cellulose fibers with gaseous HCl mixed with hot air. Extensive analytical characterization using FT-IR, XRD, SEM, TGA, DSC, particle size, and porosity analyses verified comparable physicochemical attributes between MCC samples prepared via liquid and gas phase methods. The gas-produced MCC revealed 85% crystallinity, 71 Å crystallite dimensions, and thermally stable rod-shaped morphology with an average diameter below 200 µm. The similar material properties validate the proposed gas-based technique as an equally effective yet more energy-efficient alternative to conventional aqueous acid hydrolysis for fabricating highly pure MCC powders from lignocellulose. This sustainable approach enables the value-addition of sugarcane bagasse agro-industrial residue into cellulosic nanomaterials for wide-ranging industrial applications. In summary, the key achievements of this work are rapid MCC production under mild temperatures using HCl gas, optimization of liquid phase hydrolysis, successful demonstration of gas phase method, and extensive characterization verifying equivalence between both protocols. The gas methodology offers a greener cellulose extraction process from biomass.

Eco-friendly anti-corrosion performance of chitosan modified with fused heterocyclic compound on mild steel in acidic medium.

This study aims to explore the prevention of chitosan modified with a fused heterocyclic compound as a sustainable corrosion inhibitor for mild steel in 1 M HCl. Electrochemical instruments, including potentiodynamic polarization techniques, and electrochemical impedance spectroscopy (EIS), were employed to evaluate the corrosion protection performance. The outcomes showed that the chitosan modified with a fused heterocyclic compound has outstanding inhibition performance, with an inhibition effectiveness of 98.25 % at 100 ppm. The anti-corrosion features of modified chitosan were ascribed to the presence of hetero atoms in modified chitosan composite which leads to the creation of a protective layer, The modified chitosan composite behaved as mixed-typed inhibitors, as shown by the PDP results. The modified chitosan composite adsorbs on mild steel in the investigated corrosive media via chemisorption interactions, and its adsorption followed the Langmuir adsorption model. Furthermore, increasing the temperature from 303 to 333 K enhanced the corrosion rate, most likely due to the desorption of the inhibitor agent from the steel surface.

DTTZ suppresses ferroptosis and reverses mitochondrial dysfunction in normal tissues affected by chemotherapy.

Conventional antineoplastic therapies cause severe normal tissue damage and existing cytoprotectants with acute toxicities or potential tumor protection limit their clinical application. We evaluated the selective cytoprotection of 2,2-dimethylthiazolidine hydrochloride in this study, which could protect normal tissue toxicity without interfering antineoplastic therapies. By using diverse cell lines and A549 xenograft model, we discovered a synthetic aminothiol 2,2-dimethylthiazolidine hydrochloride selectively diminished normal cellular ferroptosis via SystemXc-/Glutathione Peroxidase 4 pathway upon antineoplastic therapies without interfering the anticancer efficacy. We revealed the malignant and non-malignant tissues presenting different energy metabolism patterns. And cisplatin induces disparate replicative stress, contributing to the distinguishable cytoprotection of 2,2-dimethylthiazolidine in normal and tumor cells. The compound pre-application could mitigate cisplatin-induced normal cellular mitochondrial oxidative phosphorylation (OXPHOS) dysfunction. Pharmacologic ablation of mitochondria reversed 2,2-dimethylthiazolidine chemoprotection against cisplatin in the normal cell line. Combined, these results provide a potential therapeutic adjuvant to selectively diminish normal tissue damages retaining antineoplastic efficacy.

A high loading nanocarrier for the 5-fluorouracil anticancer drug based on chloromethylated graphene.

In the present work, we report a facile and simple strategy to functionalize graphene with the chloromethyl (CH2Cl) functional group as a nanoplatform for effectual loading of the 5-fluorouracil (5-FU) anticancer drug. To achieve the highest loading capacity, hydrochloric acid concentration, the quantity of paraformaldehyde, ultrasonic treatment time, and stirring duration were all carefully optimized. The results revealed that the optimum conditions for functionalizing graphene were obtained at 70 mL of hydrochloric acid, 700 mg of paraformaldehyde, and times of 35 min and 2 h of ultrasonication and stirring. Later, the drug (5-FU) was loaded onto CH2Cl-functionalized graphene through hydrogen bonding and π-π interactions. The chemical structure of the functionalized material and the loading of the 5-FU drug were confirmed by FTIR analysis, scanning electron microscopy, and X-ray photoelectron spectroscopy. The 5-FU loading capacity of as-prepared materials was determined using the ion chromatography instrument. Our findings demonstrate that chloromethylated graphene is a very excellent nano-platform for high-efficiency drug loading, yielding a loading capacity of 52.3%, comparatively higher than pure graphene (36.54%).

Origanum Grosii Extracts as Novel Eco-Friendly Corrosion Inhibitors for Mild Steel In HCl Medium.

Two green inhibitors extracted from an endemic species (Origanum grosii (Og)) using two solvents of different polarity (water and ethanol), OgW (aqueous extract) and OgE (ethanolic extract), were used for the anticorrosion of mild steel (M steel) in a 1 M HCl medium. Anticorrosive performance of OgW and OgE was assessed using standard electrochemical techniques, EIS/PDP measurements, weight loss method and SEM/EDX surface analysis. The results show that OgW achieves a maximum inhibition efficiency of 92 % and that the extract in aqueous medium (more polar) is more efficient than the extract in ethanolic medium (less polar). Both extracts act as mixed inhibitors and their corrosion process is predominantly governed by a charge transfer. Concentration and temperature effect was studied and shown that they are two antagonistic parameters for the evolution of inhibitory effectiveness of both OgW and OgE. The adsorption isotherms of the two inhibitors OgE and OgW obey to the Langmuir adsorption model. Moreover, the examination of SEM images and EDX spectra support a deposit of both extracts on the metal surface by an adsorption phenomenon. Besides, theoretical approach of the molecular structures of the major compounds M-OgW and M-OgE and inhibition efficiency was examined via DFT calculations and molecular dynamics simulations and it was consistent with the experimental findings.

[A case of acute respiratory distress syndrome induced by inhalation of hydrogen chloride].

Poisoning induced by inhalation of hydrogen chloride has significant effects on the respiratory system. It can cause severe pulmonary edema and acute respiratory distress syndrome (ARDS) in the early stage, and even death in critical cases. As a novel treatment for ARDS, the efficacy of sivelestat sodium in infection-induced ARDS has been widely verified, but its application in ARDS caused by chemical poisoning is still scarce in literature. Here we report a case of ARDS induced by hydrogen chloride inhalation which was successfully treated with sivelestat sodium and conventional treatment.

HSP70 Is a Critical Regulator of HSP90 Inhibitor's Effectiveness in Preventing HCl-Induced Chronic Lung Injury and Pulmonary Fibrosis.

Exposure to hydrochloric acid (HCl) can provoke acute and chronic lung injury. Because of its extensive production for industrial use, frequent accidental exposures occur, making HCl one of the top five chemicals causing inhalation injuries. There are no Food and Drug Administration (FDA)-approved treatments for HCl exposure. Heat shock protein 90 (HSP90) inhibitors modulate transforming growth factor-ß (TGF-ß) signaling and the development of chemical-induced pulmonary fibrosis. However, little is known on the role of Heat Shock Protein 70 (HSP70) during injury and treatment with HSP90 inhibitors. We hypothesized that administration of geranylgeranyl-acetone (GGA), an HSP70 inducer, or gefitinib (GFT), an HSP70 suppressant, alone or in combination with the HSP90 inhibitor, TAS-116, would improve or worsen, respectively, HCl-induced chronic lung injury in vivo and endothelial barrier dysfunction in vitro. GGA, alone, improved HCl-induced human lung microvascular endothelial cells (HLMVEC) barrier dysfunction and, in combination with TAS-116, improved the protective effect of TAS-116. In mice, GGA reduced HCl toxicity and while TAS-116 alone blocked HCl-induced chronic lung injury, co-administration with GGA, resulted in further improvement. Conversely, GFT potentiated HCl-induced barrier dysfunction and impaired the antidotal effects of TAS-116. We conclude that combined treatments with HSP90 inhibitors and HSP70 inducers may represent a novel therapeutic approach to manage HCl-induced chronic lung injury and pulmonary fibrosis.

Effects of repeated etching cycles using 15% hydrochloric acid on enamel loss and relative attenuation coefficient in resin infiltration.

BACKGROUND: Resin infiltration is used to mask enamel opacities and the recommended etching cycles are three. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles. AIM: To determine the incremental and total enamel loss when enamel surfaces are exposed to multiple etching cycles and to assess the relative attenuation coefficient after multiple etching cycles and resin infiltration treatment. METHODS: Ninety extracted sound human premolars teeth were divided into 9 groups (n = 10); with each consecutive group having one additional etching cycle up to 9 cycles. The teeth were scanned with optical coherence tomography and enamel loss and attenuation coefficient were measured with MATLAB software. Enamel loss (one-way ANOVA, p ≤ 0.05) and attenuation coefficient (two-way ANOVA, p ≤ 0.05) were statistically analyzed. RESULTS: There was a significant total enamel loss of more than 33% found at the 7th etching cycle and more. There was no statistically significant difference in the incremental mean depth of penetration of resin between various etching cycles (F(8, 134) = [2.016], one-way ANOVA, p = 0.185). CONCLUSION: This study recommends that etching should not be repeated more than seven cycles to prevent excessive enamel loss. Following eight etching cycles, resin infiltration penetration appears approximately equal to that of healthy enamel.

VALOR-CKD: A Multicenter, Randomized, Double-Blind Placebo-Controlled Trial Evaluating Veverimer in Slowing Progression of CKD in Patients with Metabolic Acidosis.

SIGNIFICANCE STATEMENT: Metabolic acidosis is a common complication of CKD and is associated with more rapid decline of kidney function, but well-powered controlled randomized trials testing the effect of treating metabolic acidosis on slowing CKD progression have not been conducted. The VALOR-CKD study randomized 1480 individuals with CKD and metabolic acidosis, across 320 sites to placebo or veverimer (a novel hydrochloric acid binder). The findings did not demonstrate the efficacy of veverimer in slowing CKD progression, but the difference in serum bicarbonate between placebo and drug arms was only approximately 1 mEq/L. Veverimer was safe and well tolerated. BACKGROUND: Metabolic acidosis is common in CKD, but whether its treatment slows CKD progression is unknown. Veverimer, a novel hydrochloric acid binder that removes acid from the gastrointestinal tract, leads to an increase in serum bicarbonate. METHODS: In a phase 3, double-blind, placebo-controlled trial, patients with CKD (eGFR of 20-40 ml/min per 1.73 m 2 ) and metabolic acidosis (serum bicarbonate of 12-20 mEq/L) from 35 countries were randomized to veverimer or placebo. The primary outcome was the composite end point of CKD progression, defined as the development of ESKD (kidney transplantation or maintenance dialysis), a sustained decline in eGFR of ≥40% from baseline, or death due to kidney failure. RESULTS: The mean (±SD) baseline eGFR was 29.2±6.3 ml/min per 1.73 m 2 , and serum bicarbonate was 17.5±1.4 mEq/L; this increased to 23.4±2.0 mEq/L after the active treatment run-in. After randomized withdrawal, the mean serum bicarbonate was 22.0±3.0 mEq/L and 20.9±3.3 mEq/L in the veverimer and placebo groups at month 3, and this approximately 1 mEq/L difference remained stable for the first 24 months. A primary end point event occurred in 149/741 and 148/739 patients in the veverimer and placebo groups, respectively (hazard ratio, 0.99; 95% confidence interval, 0.8 to 1.2; P = 0.90). Serious and overall adverse event incidence did not differ between the groups. CONCLUSIONS: Among patients with CKD and metabolic acidosis, treatment with veverimer did not slow CKD progression. The lower than expected bicarbonate separation may have hindered the ability to test the hypothesis. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: VALOR-CKD, NCT03710291 .