Acid Levels In Patients Research Articles

Therapeutic Efficiency of Lowering Branched-Chain Amino Acid Levels in Patients with Type 2 Diabetes Using Sodium-Phenylbutyrate: <i>A Randomized Placebo Controlled Clinical Intervention Study</i>

Background: Elevations in plasma branched-chain amino acid (BCAA) levels associate with insulin resistance and type 2 diabetes (T2D). Pre-clinical models have suggested that lowering BCAA levels improve glucose tolerance, but data in humans are lacking. In the present study, we used sodium phenylbutyrate (NaPB), an accelerator of BCAA catabolism, as a tool to lower plasma BCAA levels in patients with T2D, and to evaluate its effect on patients’ metabolic health. Methods: This trial had a randomized, placebo-controlled, double-blind cross-over design and was performed in the Netherlands. Patients were eligible for the trial if they were 40-75years, BMI of 25-38 kg/m², relatively well-controlled T2D (HbA1C<8.5%) and treated with oral glucose-lowering medication. Participants were randomly assigned to receive either the NaPB 4.8g/m²/day or placebo three times a day for two weeks, separated by a washout period of six to eight weeks. The primary outcome was peripheral insulin sensitivity. Secondary outcomes were ex vivo muscle mitochondrial oxidative capacity, whole-body substrate oxidation, ectopic fat accumulation. Fasting blood samples were collected to determine levels of BCAA and their intermediates. The trial is registered with Netherlands Trial Register, NTR 7426. Findings: Between February 2019 and February 2020, sixteen patients were included. NaPB effectively led to a robust improvement in peripheral insulin sensitivity (ΔRd:13.2±1.8 vs. 9.6±1.8 µmol/kg/min, p=0.0155), carbohydrate-driven muscle mitochondrial oxidative capacity (O2-flux:74.0±4.1 vs. 67.1±4.3 pmol/(s*mg), p=0.0417), whole-body insulin-stimulated carbohydrate oxidation (10.9±0.6 vs. 9.6±0.7 µmol/kg/min, p=0.0246), and reduced plasma BCAA (549.2±4.5 vs. 598.4±5.0 µmol/L, p=0.0125) and oxidation-derived metabolites (KIV:13.4±0.1 vs. 15.2±0.1 µmol/L, p=0.0154; 3-HIB:36.94±0.7 vs. 43.5±0.6 µmol/L, p=0.0194:). No adverse events were reported. Interpretation: In patients with T2D, NaPB treatment significantly improved peripheral insulin sensitivity and glucose oxidation. These data establish the proof-of-concept in humans that targeting the BCAA pathway may represent a potential new treatment strategy for patients with T2D. Trial Registration: The trial has been registered with number NTR 7426, direct link to the trial: https://www.trialregister.nl/trial/7227. Funding: Dutch Diabetes Foundation Declaration of Interest: The authors declare no conflicts of interest. Ethical Approval: The study was conducted at the Maastricht University Medical Center (MUMC+), the Netherlands. The protocol was reviewed and approved by the Medical Review Ethics Committee of Maastricht University and Medical Centre.

Evaluation of Vitamin D, Vitamin B12 and Folic Acid Levels in Patients with Carpal Tunnel Syndrome

Evaluation of Vitamin D, Vitamin B12 and Folic Acid Levels in Patients with Carpal Tunnel Syndrome

Prognostic impacts of serum uric acid levels in patients with chronic heart failure: insights from the CHART-2 study.

AimsPrognostic impacts of serum uric acid (UA) levels in patients with chronic heart failure (CHF) remain inconclusive, especially for the whole range of serum UA levels.Methods and resultsIn the Chronic Heart Failure Registry and Analysis in the Tohoku District‐2 (CHART‐2) study, we enrolled 4652 consecutive patients with CHF and classified them into four groups based on baseline serum UA levels by the Classification and Regression Tree: G1 (<3.8 mg/dL, N = 313), G2 (3.8–7.1 mg/dL, N = 3070), G3 (7.2–9.2 mg/dL, N = 1018), and G4 (>9.2 mg/dL, N = 251). Mean age was 71 ± 12, 69 ± 12, 68 ± 13, and 69 ± 15 years in G1, G2, G3, and G4, respectively (P < 0.001). During the median follow‐up of 6.3 years, in G1, G2, G3, and G4, 111 (35%), 905 (29%), 370 (36%), and 139 (55%) patients died and 79 (25%), 729 (24%), 300 (29%), and 115 (46%) experienced heart failure hospitalization, respectively (both P < 0.001). G1 was characterized by a significantly high prevalence of women as compared with G2, G3, and G4 (59%, 32%, 24%, and 23%, respectively). Serum creatinine levels (0.8 ± 0.4, 0.9 ± 0.4, 1.2 ± 0.6, and 1.4 ± 0.8 mg/dL, respectively), prevalence of atrial fibrillation (34%, 39%, 45%, and 50%, respectively), and diuretics use (36%, 45%, 67%, and 89%, respectively) increased from G1, G2, G3 to G4 (all P < 0.001), while left ventricular ejection fraction decreased from G1, G2, G3 to G4 (59 ± 15, 58 ± 15, 54 ± 15, and 52 ± 17%, respectively, P < 0.001). Multivariable Cox proportional hazards models showed that, as compared with G2, both G1 and G4 had increased incidence of all‐cause death [adjusted hazard ratio (aHR) 1.34, 95% confidence interval (CI) 1.08–1.67, P = 0.009; aHR 1.28, 95% CI 1.02–1.61, P = 0.037, respectively] and heart failure admission (aHR 1.39, 95% CI 1.09–1.78, P = 0.008 and aHR 1.35, 95% CI, 1.06–1.71, P = 0.014, respectively). This U‐shaped relationship was evident in the elderly patients. Furthermore, abnormal transitions to either higher or lower levels of serum UA from G2 were associated with increased mortality (aHR 1.29, 95% CI 1.06–1.57, P = 0.012; aHR 1.57, 95% CI 1.12–2.20, P = 0.009).ConclusionsThese results demonstrate that serum UA levels have the U‐shaped prognostic effects and abnormal transitions to either higher or lower levels are associated with poor prognosis in the elderly patients with CHF.

Assessment of Serum Uric Acid Levels in Patients with Acute Myocardial Infarction

Background : Aim of the study was to discover if there is the efficacy of serum uric acid in the prognostication of myocardial infarction subjects. Subjects and Methods: A total of 200 subjects were incorporated into the research. Of them, 74 patients had ST- elevated myocardial infarction, as in 26 subjects they were diagnosed with non-ST elevation myocardial infarction. Of the total of 100 subjects in the study group, there were 70 males and 30 females. A total of 100 healthy individuals as a control group were also incorporated in the study. Serum uric acid was measured on day 0, 3, 7 as well on day 30 of MI. Results: Serum uric acid was calculated on day 0, day 3, and day 7 and on day 30 of the myocardial infarction in the case study group. The mean uric acid levels on day 0 were found to be 6.32 1.45 mg/dl, mean uric acid level on day 3 was found to be 5.98 0.98 mg/dl, mean uric acid level on day 7 was found to be 5.14 2.18 mg/dl and mean uric acid level on day 30 was found to be 4.98 0.44 mg/dl. Conclusion: Serum uric acid stages are elevated in subjects of acute MI in contrast to standard well individuals. Subjects with higher Serum uric acid levels have an elevated probability of transience and it can be measured as a marker of appalling prediction.

Correlation of serum uric acid levels in patients of chronic obstructive pulmonary disease

To evaluate serum uric acid level and correlate with the classification of chronic obstructive pulmonary disease (COPD) severity based on post-bronchodilator FEV1 as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. It is an institution based cross-sectional study in which 100 patients were included. Patients were screened for COPD. Clinical profile and oxygen saturation were included. Patients were classified according to GOLD guidelines. We found that serum uric acid level was at higher side in patients of severe and very severe stages of COPD compared to mild and moderate stages. Inverse relationship found between FEV1 and serum uric acid level. We concluded that uric acid is a widely available, easy to interpret, low cost biomarker, suggests the possible role in the identification of COPD patients of increased risk for adverse outcomes that may need early intensive management. Keywords: Chronic obstructive pulmonary disease, GOLD guidelines, Spirometry, Serum uric acid.

Assessment of glycated hemoglobin and uric acid level in polycystic ovarian syndrome in a Tertiary Care Institute of Marathwada region

Introduction: The Polycystic Ovary Syndrome (PCOS) is one of the most common reproductive endocrine disorders, affecting 5–10% of women in the reproductive age. Insulin resistance is the hallmark of this disorder. PCOS has been epidemiologically linked to an increased risk for type 2 diabetes mellitus and cardiovascular diseases. The present study was planned to study glycated hemoglobin (HbA1c) and uric acid level in patients of PCOS. Materials and Methods: The study comprised of 60 women with PCOS as cases and 60 healthy females as controls. HbA1c and uric acid level were measured in all participants. Results: Glycated hemoglobin and serum uric acid were significantly increased in PCOS group and showed positive correlation with body mass index and waist: hip ratio. The prevalence of raised HbA1c was 40% in PCOS women. Conclusion: In our study we found significant alterations in HbA1c and uric acid level in cases of PCOS. Early identification of these changes and timely intervention can reduce morbidity due to type 2 diabetes mellitus and cardiovascular diseases in PCOS. This will help to redefine the paradigms of PCOS care in India. Keywords: Cardiovascular Disease, HbA1c, PCOS, Type 2 Diabetes Mellitus, Uric Acid.

Analysis of Serum Uric Acid Level in Patients with and without Diabetic Nephropathy

Diabetic nephropathy is one of the microvascular complications in type 2 Diabetes Mellitus (DM). Diagnosis of diabeticnephropathy is based on any history of DM, a decrease in Glomerular Estimation Filtrate Rate (eGFR) using the CKD-Epiformula, and albuminuria. The role of serum uric acid level in diabetic nephropathy remains an ongoing debate. Serum uricacid levels may be the cause or the result of diabetic nephropathy. This study aimed to analyze serum uric acid levels inpatients with and without diabetic nephropathy and determine its correlation with diabetic nephropathy. This study wasperformed at Dr. Wahidin Sudirohusodo Hospital, Makassar, by taking the data from the medical record of type 2 DMpatients from January to April 2018. Fifty-nine patients with diabetic nephropathy and 150 patients without diabeticnephropathy participated in this study. An independent T-test and Pearson's correlation test were used for statisticalanalysis. There was a significant difference in uric acid level between patients with and without diabetic nephropathy(9.57±3.42 mg/dL vs. 6.41±2.86 mg/dL, p &lt; 0.001). There was significant correlation between uric acid serum levels with urea(p &lt; 0.001, r=0.585), creatinine (p&lt;0.001, r=0.413) and eGFR (p &lt; 0.001, r=-0.525) in patients with diabetic nephropathy. Uricacid levels in patients with diabetic nephropathy were higher than patients without diabetic nephropathy. Higher levels ofurea and the serum creatinine led to higher levels of serum uric acid. Contrastingly, a lower eGFR rate led to higher levels ofuric acid.

Collagen remodelling and plasma ascorbic acid levels in patients suspected of inherited bleeding disorders harbouring germline variants in collagen-related genes.

IntroductionVariants in collagen‐related genes COL1A1, COL3A1, COL5A1 and COL5A2 are associated with Ehlers‐Danlos syndrome (EDS), a heterogeneous group of connective tissue disorders strongly associated with increased bleeding. Of patients with incompletely explained bleeding diathesis, a relatively high proportion were shown to harbour at least one heterozygous variant of unknown significance (VUS) in one of these genes, the vast majority without meeting the clinical criteria for EDS.AimTo investigate the functional consequences of the identified variants by assessing the formation and degradation of types I, III and V collagen, in addition to plasma levels of ascorbic acid (AA).MethodsA total of 31 patients harbouring at least one heterozygous VUS in COL1A1, COL3A1, COL5A1 or COL5A2 and 20 healthy controls were assessed using monoclonal antibodies targeting neo‐epitopes specific for collagen formation and degradation. Plasma AA levels were measured in patients using high‐performance liquid chromatography.ResultsSerum levels of C5 M (degradation of type V collagen) were decreased in patients compared with healthy controls (p = .033). No significant differences were found in biomarkers for remodelling of types I and III collagen. A significant negative correlation between bleeding (ISTH‐BAT score) and plasma AA levels was shown (r = −.42; r2 = .17; p = .020). Suboptimal or marginally deficient AA status was found in 8/31 patients (26%).ConclusionFunctional investigations of collagen remodelling were not able to identify any clear associations between the identified variants and increased bleeding. The negative correlation between plasma AA levels and ISTH‐BAT score motivates further investigations.

Effects of dapagliflozin on serum and urinary uric acid levels in patients with type 2 diabetes: a prospective pilot trial

BackgroundWe aimed to evaluate the effects of short-term therapy with dapagliflozin on serum uric acid (SUA) and urinary uric acid (UUA) levels in patients with type 2 diabetes.MethodsIn this prospective pilot trial, 8 patients with type 2 diabetes mellitus were assigned to the treatment group with dapagliflozin 10 mg once daily for one week, and 7 subjects with normal glucose tolerance were recruited into the control group. Data of anthropometric measurements, SUA, 24-h UUA, fractional excretion of UA (FEUA), serum lipid parameters and 3-h oral glucose tolerance test (OGTT) were collected in both treatment and control groups; all examinations were repeated after treatment. The area under the curve of glucose (AUCGlu) was calculated to reflect the general glucose levels, while insulin resistance and islet β-cell function were reflected by indexes calculated according to the data obtained from the OGTT.ResultsThe weight and serum lipid parameters showed no differences before and after treatment with dapagliflozin for one week. We found SUA levels decreased from 347.75 ± 7.75 μmol/L before treatment to 273.25 ± 43.18 μmol/L after treatment, with a statistically significant difference (P = 0.001) and was accompanied by a significant increase in FEUA from 0.009 to 0.029 (P = 0.035); there was a linear correlation between SUA and FEUA levels. Glucose control, insulin sensitivity and islet β-cell function were improved to a certain extent. We also found a positive correlation between the decrease in glucose levels and the improvement in islet β-cell function.ConclusionsThe SUA-lowering effect of dapagliflozin could be driven by increasing UA excretion within one week of treatment, and a certain degree of improvement in glucose levels and islet β-cell function were observed.Trial registration ClinicalTrials.gov identifier, NCT04014192. Registered 12 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04014192:term=NCT04014192&draw=2&rank=1. Yes.

Uric acid as a predictor of endothelial dysfunction in patients with metabolic syndrome.

We conducted a study to examine the association of endothelial dysfunction and oxidative stress with uric acid levels in patients of metabolic syndrome. One hundred and two patients of Metabolic Syndrome (International Diabetes Federation definition) were included in the study. Anthropometric measurements, serum uric acid levels, fasting blood sugar levels and lipid levels, as well as malondialdehyde and reactive nitrogen intermediates were measured after an 8-hour fasting period. Flow mediated vasodilation (FMD) of the brachial artery was measured and endothelial dysfunction was defined as an increase in diameter < 10% post compression. A total of 102 patients were included in the study. Mean uric acid level was 5.49 ± 1.61 mg%. A total of 59 patients in the study had endothelial dysfunction, defined by an abnormal FMD. Patients with an abnormal FMD had higher levels of serum uric acid which was statistically significant (p value = 0.010). Serum RNI and MDA levels were negatively correlated with uric acid, but did not reach statistical significance. Patients with an abnormal FMD had a lower RNI level, but this did not reach statistical significance. Serum MDA levels were significantly higher in patients with an abnormal FMD (p value = 0.038). Uric acid was significantly associated with endothelial dysfunction in patients with metabolic syndrome in our study. It was inversely correlated with serum RNI and MDA levels, but this did not reach statistical significance.

Клініко-інструментальна характеристика пацієнтів із хронічною серцевою недостатністю та зниженою фракцією викиду лівого шлуночка залежно від наявності цукрового діабету 2-го типу

Мета роботи – порівняти клініко-інструментальні показники в пацієнтів із хронічною серцевою недостатністю (ХСН) та зниженою фракцією викиду лівого шлуночка (ФВЛШ) залежно від наявності в них цукрового діабету (ЦД) 2-го типу.Матеріали і методи. Проаналізовано 490 історій хвороб пацієнтів, які спостерігалися у відділі серцевої недостатності в період з 2011 до 2018 р., з ХСН ІІ–ІV функціонального класу за NYHA, ФВЛШ ≤ 40 %, віком 40–80 років (медіана (верхній; нижній квартилі) – 64 (56,00; 69,00) роки). До досліджуваної групи увійшли переважно хворі з ішемічною хворобою серця (ІХС) у поєднанні з гіпертонічною хворобою (ГХ) – 403 (82,2 %) пацієнти, з ізольованою ІХС – 55 (11,2 %) та з ізольованою ГХ – 32 (6,6 %). Більшість хворих (278 (56,7 %) осіб) мали постійну форму фібриляції передсердь. Серед досліджуваних було 373 (76,1 %) чоловіки та 117 (23,9 %) жінок. Пацієнтів залучали в дослідження у фазу клінічної компенсації, тобто в еуволемічному стані. Для аналізу всіх пацієнтів з ХСН та зниженою ФВЛШ розподілили на дві групи: в І групу увійшли 338 (69 %) хворих без ЦД, ІІ групу становили 152 (31 %) пацієнти з діагностованим ЦД 2-го типу.Результати та обговорення. За результатами аналізу не виявлено статистично значущих відмінностей між досліджуваними групами за віком пацієнтів, загальними показниками гемодинаміки, середньодобовою частотою серцевих скорочень, функціональним класом ХСН за NYHA, частотою супутнього хронічного обструктивного захворювання легень та тривалістю існування ознак ХСН. Зафіксовано меншу частку пацієнтів з фібриляцією передсердь у ІІ групі, більший показник індексу маси тіла пацієнтів у І групі, показник Е/е΄ та індекс маси міокарда лівого шлуночка були більшими в пацієнтів без супутнього ЦД. У ході дослідження виявили значно вищий рівень сечової кислоти в пацієнтів із супутнім ЦД 2-го типу, за показниками оксидативного стресу та прозапальних маркерів, рівня NT-proBNP та інсуліну статистично значущої різниці між групами не встановлено. Також не спостерігали статистично значущої різниці між групами щодо значень потокозалежної вазодилатації. Показано, що поєднання ІХС та ЦД 2-го типу є основним фактором високої летальності в пацієнтів з ХСН. Утім не виявлено різниці щодо тривалості життя пацієнтів з ХСН та зниженою ФВЛШ із ЦД 2-го типу та без ЦД. Також виявлено статистично значуще гірше виживання пацієнтів з рівнем глікованого гемоглобіну понад 7,4 %.Висновки. П’ятирічна виживаність пацієнтів з ХСН зі зниженою ФВЛШ із ЦД 2-го типу та без ЦД статистично значуще не відрізнялася, тоді як у загальній групі гіршу 5-річну виживаність зареєстровано для тих хворих, які мали показник глікованого гемоглобіну понад 7,4 %.

Muscle Mitochondrial Function and Physical Performance Are Associated with Branched-Chain Amino Acid Levels in Patients with CKD

Muscle Mitochondrial Function and Physical Performance Are Associated with Branched-Chain Amino Acid Levels in Patients with CKD

The prognostic impact of the uric acid level in patients who require cardiovascular intensive care - is serum uric acid a surrogate biomarker for critical patients in the non-surgical intensive care unit?

The prognostic impact of hyperuricemia and the factors that induce hyperuricemia in cardiovascular intensive care patients remain unclear. A total of 3257 emergency department patients were screened, and data for 2435 patients who were admitted to an intensive care unit were analyzed. The serum uric acid level was measured within 15 min of admission. The patients were assigned to a low-uric acid group (uric acid ⩽7.0 mg/dl, n=1595) or a high-uric acid group (uric acid >7.0 mg/dl, n=840) according to their uric acid level on admission. Thereafter, the patients were divided into four groups according to the quartiles of their serum uric acid level (Q1, Q2, Q3 and Q4), and uric acid levels and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. A Kaplan-Meier curve showed a significantly lower 365-day survival rate in a high-uric acid group than in a low-uric acid group, and in Q3 than in Q1 or Q2 and in Q4 than in the other groups. The multivariate logistic regression model for 30-day mortality identified Q4 (odds ratio: 1.856, 95% confidence interval (CI) 1.140-3.022; p=0.013) as an independent predictor of 30-day mortality. The area under the receiver-operating characteristic curve values of the serum uric acid level and APACHE II score for the prediction of 30-day mortality were 0.648 and 0.800, respectively. The category-free net reclassification improvement and integrated discrimination improvement showed that the calculated risk shifted to the correct direction by adding the serum uric acid level to the APACHE II score (0.204, 95% CI 0.065-0.344; p=0.004, and 0.015, 95% CI 0.005-0.025; p=0.004, respectively). The prognosis, including the 365-day mortality, among patients with a high uric acid level and a high APACHE II score was significantly poorer in comparison with other patients. The serum uric acid level, which might be elevated by the various critical stimuli on admission, was an independent predictor in patients who were emergently hospitalized in the intensive care unit. The serum uric acid level is therefore useful as a surrogate biomarker for critical patients in the intensive care unit.

Hyperuricemia as risk factor for cardiovascular disease – what’s new?

A significant number of epidemiological studies have shown that hyperuricemia is highly associated with the risk of developing cardiovascular disease, chronic kidney disease, and diabetes. In this connection, increased attention is required to monitor serum uric acid levels in patients, not only from a rheumatological point of view, but also with regard to reducing cardiovascular and renal risks. This article is a review of studies on the association of hyperuricemia with cardiovascular risk and a new consensus for the management of patients with hyperuricemia and high cardiovascular risk, published in december 2019 by a group of experts of the Russian Medical Society for Arterial Hypertension, which, among other things, includes a management algorithm of this category of patients.

Glutamine depletion in patients with Crimean-Congo hemorrhagic fever.

Crimean-Congo hemorrhagic fever (CCHF) is a viral disease. There is not enough knowledge about plasma amino acid levels in CCHF. Therefore, we investigated plasma amino acid levels in patients with CCHF and the association between the levels of these amino acids and disease severity. The plasma amino acid levels (including glutamate [Glu], aspartate [Asp], glutamine [Gln], asparagine [Asn] and gamma-aminobutyric acid [GABA]) in CCHF patients and controls were measured by using liquid chromatography-mass spectrometry. Plasma levels of Gln were lower while Asp, Glu, and GABA levels were higher in patients. In fatal CCHF patients, we found the plasma level of Asn was increased whereas the plasma level of GABA was decreased. This study is the first in the literature to evaluate the plasma Gln, Glu, Asn, Asp, and GABA levels in CCHF patients. We found that the plasma Gln levels were significantly lower in CCHF patients while Asp, Glu, and GABA levels were elevated. Considering that these amino acids are important for immune cells, the plasma amino acid levels of CCHF patients may contribute to the understanding of the pathophysiology of disease and it can be important for supportive treatment of CCHF.

Basal insulin ameliorates post-breakfast hyperglycemia via suppression of post-breakfast proinsulin/C-peptide ratio and fasting serum free fatty acid levels in patients with type 2 diabetes.

In general, basal insulin targets fasting plasma glucose (FPG) levels, and prandial insulin targets postprandial glucose (PPG) levels. However, the effects of basal insulin on PPG levels are controversial. We investigated the effect of basal insulin on postprandial hyperglycemia using a test meal at breakfast as well as compared differences between degludec and glargine. A total of 20 participants with type 2 diabetes were randomly assigned to degludec (n = 10) or glargine (n = 10). We initiated basal-bolus insulin therapy and titrated only basal insulin until FPG was < 6.1mmol/L. We evaluated changes in post-breakfast glucose levels and changes in clinical parameters such as serum C-peptide (CPR), proinsulin (PI), and free fatty acids (FFA) levels between the pre- and post-titration periods. Differences between degludec and glargine in the post-titration period were also evaluated. Post-breakfast glucose levels significantly decreased by 46.1% in the post-titration period compared with the pre-titration period (n = 20, p < 0.001). These decreases correlated positively with decreases in the post-breakfast PI/CPR ratio (r = 0.692, p < 0.001) and in fasting FFA levels (r = 0.720, p < 0.001). There were no significant differences in post-breakfast glucose levels between degludec and glargine. However, the hypoglycemic rate with degludec was significantly lower than with glargine. Our results suggest that basal insulin with either degludec or glargine decreases the incidence of post-breakfast hyperglycemia accompanied by decreasing the post-breakfast PI/CPR ratio and fasting FFA levels in patients with type 2 diabetes.

Efficacy of different urinary uric acid indicators in patients with chronic kidney disease

BackgroundMounting studies have shown that hyperuricemia is related to kidney diseases through multiple ways. However, the application of urinary uric acid indicators in patients with reduced renal function is not clear. In this study, we aim to determine the effects of renal function on various indicators reflecting uric acid levels in patients with chronic kidney disease (CKD).MethodsAnthropometric and biochemical examinations were performed in 625 patients with CKD recruited from Dept of Nephrology of Huadong hospital affiliated to Fudan University. Multiple regression analyses were used to study correlations of the estimated glomerular filtration rate (eGFR) with serum uric acid (SUA) and renal handling of uric acid. For further study, smooth curve plots and threshold effect analyses were applied to clarify associations between renal function and uric acid levels.ResultsThe nonlinear relationships were observed between eGFR and urinary uric acid indicators. The obvious inflection points were observed in smooth curve fitting of eGFR and fractional excretion of uric acid (FEur), excretion of uric acid per volume of glomerular filtration (EurGF). In subsequent analyses where levels of eGFR< 15 mL/min/1.73m2 were dichotomized (CKD5a/CKD5b), patients in the CKD5a showed higher levels of FEur and EurGF while lower levels of urinary uric acid excretion (UUA), clearance of uric acid (Cur) and glomerular filtration load of uric acid (FLur) compared with CKD5b group (all P < 0.05). And there was no significant difference of SUA levels between two groups. On the other hand, when eGFR< 109.9 ml/min/1.73 m2 and 89.1 ml/min/1.73 m2, the resultant curves exhibited approximately linear associations of eGFR with Cur and FLur respectively.ConclusionFEur and EurGF showed significantly compensatory increases with decreased renal function. And extra-renal uric acid excretion may play a compensatory role in patients with severe renal impairment to maintain SUA levels. Moreover, Cur and FLur may be more reliable indicators of classification for hyperuricemia in CKD patients.

Evaluating serum uric acid levels in patients with acute myocardial infarction

Background: Elevated levels of serum uric acid are associated with increased cardiovascular morbidity and mortality. However, this association with cardiovascular diseases is still unclear, and perhaps controversial. The objective of study was to assess the serum uric acid level in patients with Acute Myocardial Infarction (AMI).Methods: Sixty patients with AMI were studied in Department of Medicine/ Department of Cardiology, J.A. Group of Hospitals between 2016 -2018.Details of age, sex, smoking, alcohol consumption and history of ischemic heart disease (IHD) was obtained and recorded. Serum uric acid level was estimated and compared with control group (healthy subjects).Results: Serum uric acid level was significantly higher among AMI patients (6.43±2.60) as compared to control group (4.05±0.95) (p&lt;0.001). Majority (46.7%) of the AMI patients had uric acid level of &gt;7.1 followed by 20% patients who had uric acid level between 4.5-5.9 (p&lt;0.001). Uric acid level was comparable between smoker and non-smokers (p=0.803), alcoholic and non-alcoholic (p=0.086), hypertensive and non-hypertensive (p=0.668), patients with and without diabetes (p=0.278) and patients with a history of IHD and without history of IHD (p=0.403).Conclusions: Serum uric acid may be useful for prognostication among those with pre-existing AMI.

High expression of endothelial progenitor cell-induced angiogenic markers is associated with bile acid levels in HCC.

Endothelial progenitor cell (EPC)-induced angiogenesis activity is enhanced in hepatocellular carcinoma (HCC); however, the contributing factors remain unknown. The present study aimed to investigate the factors influencing the number of EPCs and circulating progenitor cells (CPCs), as well as the expression levels of vascular endothelial growth factor receptor 2 (VEGFR-2) and CD34, in patients with HCC. The expression levels of VEGFR-2 and CD34 were assessed in 72 HCC tumor and matched adjacent tissue microarrays by immunohistochemistry. The associations between VEGFR-2 or CD34 expression in tumors, clinicopathological characteristics and overall survival rates were analyzed. The number of EPCs and CPCs were analyzed in the peripheral blood of patients with HCC. In this study, high expression levels of VEGFR-2 and CD34 were detected in the tumor tissues of 41 (56.9%) and 44 (61.1%) patients, respectively. VEGFR-2 expression was significantly associated with tumor size (P<0.001), bile acid level (P=0.014) and α-fetoprotein level (P=0.011). However, CD34 expression was associated with tumor size (P=0.009), recrudescence (P<0.001) and bile acid (P=0.009). Next, the expression levels of VEGFR-2 and CD34 in tumor and adjacent tissues were compared according to the bile acid level. VEGFR-2 and CD34 expression levels were both higher in the high bile acid group, whereas expression levels of the markers were higher in adjacent tissues compared with tumor tissues. Kaplan-Meier curve analysis identified that patients with low CD34 expression had a longer overall survival compared with patients with high CD34 expression (P=0.029). Multivariate analysis also indicated that both VEGFR-2 (P=0.020) and CD34 (P=0.035) were independent prognostic risk factors. Moreover, flow cytometry demonstrated that the number of EPCs and CPCs was negatively related with the bile acid levels in patients with HCC. In conclusion, in patients with HCC, bile acid promotes EPC-induced angiogenesis. Furthermore, EPCs and CPCs may be activated by bile acid in tumors but are more so in adjacent tissues.

The Importance of Electrocardiography in Pediatric Patients with Pulmonary Arterial Hypertension in Follow- up

Background: Right Ventricular (RV) hypertrophy is an adaptive response to chronic RV pressure overload in patients with pulmonary hypertension. We investigated the relationships between RV hypertrophy indicators, including electrocardiography, the percentage oxygen saturation (SaO2%), body mass index (BMI), and blood uric acid levels in patients with a biventricular structure followed up for Pulmonary Arterial Hypertension (PAH). Materials and Methods: This retrospective study included 33 patients with confirmed systemic PAH, according to the catheterization and a negative vascular reactivity test result. Patients with single-ventricle physiology and Down’s syndrome who had undergone surgery were excluded. The data of blood chemistry, hemogram, ECG, and SaO2% were collected, thus, the BMI was calculated. The patients were categorized according to SaO2 values ( 90% [n=19]), BMI (18.5 [n=17] kg/m2), PAH status (primary [n=13] vs. secondary [n=20]), and treatment regime (combination therapy [n=16] vs. monotherapy [n=17]), and the data were compared among the groups. Results: Patients with SaO2 values of 90% differed only in terms of blood uric acid level, which was significantly higher in the patients with SaO2 9 mm indicating impaired capacity. These measured markers can be used to follow-up patients with PAH.