ACR Values Research Articles

High-rate partial nitritation as a pretreatment of anammox process.

In this study, a laboratory-scale partial nitrification reactor (PN reactor) was used to treat high-ammonia-nitrogen wastewater, by changing the influent NH4+-N conversion rate as the main operating strategy, to investigate the upper limit of its NH4+-N conversion rate (ACR) and explore its feasibility as an anammox pre-process. During the experiment, PN reactor was successfully activated in only 10 days. The PN reactor reached the highest ACR value of approximately 10.24 kg N/(m3 · day) when the influent ACR was 16.57 kg N/(m3 · day), and the ammonia conversion efficiency (ACE) was 61.78% at this time. The ratio of [NO2--N]Eff/[NH4+-N]Eff was approximately 1.37 which was close to the theoretical ratio of 1.32. And feasibility exploration experiment proved that it was feasible to use this PN reactor as a pre-process of anammox. The PCR-DGGE results showed that the dominant phylum and genus in the reactor during the ACR experiment were Proteobacteria and Nitrosomonas, respectively. With the increase in the ACR, the relative concentration of Nitrosomonas sp. G1 increased from 15 to 40%. This indicates that its abundance is directly correlated with the increase in the ACR. High-throughput sequencing showed that increasing the ACR of the PN reactor greatly reduced the diversity and abundance of the system microbial community structure and changed the dominant phylum and genus; however, the stability of the system was not disrupted. High-throughput sequencing experiments showed that the abundance value of nitrosation enzymes accounted for 91.62%, which was positively correlated with the expression of nitrification genes in the genus Nitrosomonas.

Serum soluble α-Klotho levels in patients with diabetic nephropathy.

The study aimed to determine the variability in the stages of diabetic nephropathy by examining specific biochemical functions associated with the target organ. As a result, various biochemical parameters were assessed in all of the groups under investigation. These parameters encompassed soluble α-Klotho and serum insulin, which were determined through ELISA. Additionally, spectrophotometric methods were employed to assess other parameters such as blood levels of urea in all groups. Instead of using HPLC method, HbA1c levels were determined. Blood and urine samples were obtained from a total of 90 participants, who were aged between 37 and 70 years. A total of 70 patients were categorized into three groups according to their ACR. The first group consisted of patients with an ACR value of less than 30 mg/g. The second group included patients with an ACR value ranging from 30 to 300 mg/g. The third group comprised patients with an ACR value greater than 300 mg. Additionally, the study also involved 20 healthy individuals. The serum soluble α-Klotho in the patient group was significantly lower than that of the healthy subjects. There were strong negative correlations between serum soluble α-Klotho and both ACR and HOMA-IR. The AUC value was excellent, measuring at 0.93 with a p < 0.0001. Soluble α-Klotho levels in the sera of diabetic patients were shown to be lower and significantly linked to patients with diabetic nephropathy. This implies that klotho levels may be influenced by ACR in addition to playing a significant role in insulin resistance.

#4519 CAN WE REPLACE URINE TESTING AND DELIVER A STEP CHANGE IN ACCESS TO RENOPROTECTIVE MEDICATIONS?

Abstract Background and Aims Albuminuria is a medical condition characterized by leakage of albumin into the urine due to kidney damage. The condition is diagnosed by heightened Albumin to Creatinine ratio in the urine (ACR) and is typically categorized into microalbuminuria (ACR ≥ 30, &amp;lt; 300 mg/g mg/g) and macroalbuminuria (ACR ≥ 300 mg/g). Currently, despite compelling data, only a minority of patients with diabetes, and rarely individuals without diabetes, are screened for albuminuria in a systematic way. ACR tests also present high intra-person variability, making it harder to identify meaningful biologic changes and increasing complexity of clinical trials. In this study we develop a method using machine learning to predict ACR level from Electronic Health Records, excluding urine tests, and validated the model for identifying patients with albuminuria. Identifying patients with undiagnosed albuminuria could help slow progression of kidney disease and be used to speed up recruitment to, and reduce screen failures in, clinical trials. Method We developed a Quantile Regression model for ACR using US Limited IBM MarketScan Explorys Claims-EMR Data Set (LCED). We included subjects who had an ACR test (0 &amp;lt; ACR ≤ 5000 mg/g) and was of at least 18 years of age. Patient demographics (age, sex), vital signs (BMI, Blood Pressure) and 8 common blood tests (Albumin, Bilirubin, Creatinine, HbA1C, Triglyceride, Glucose, White Blood Cell count &amp; ALT) were used as covariates. A tree based gradient boosting framework (LightGBM) was used to train the quantile regression models, viz., the 25-, 50-, and 75-percentiles of ACR conditioned on the covariates. The model was then validated on all qualified subjects in Optum's de-identified Clinformatics® Data Mart Database (2007-2021). We evaluated performance using the metrics Area Under the Curve (AUC), precision (PPV), specificity (TNR), and sensitivity (TPR). Finally, we use Kaplan-Meier estimates to compare the risk of progression to kidney failure as identified by ICD codes (Chronic kidney disease, stage 5; End stage renal disease; Dependence on renal dialysis; Unspecified kidney failure; Kidney transplant) of both the predicted and measured ACR values. Results A final cohort of 63,459 individuals matched the inclusion and exclusion criteria in LCED and 5,857,385 individuals in Optum. Using the 25% quantile to predict patients at risk, the model consistently reaches a PPV greater than 0.8 and a specificity (TNR) greater than 0.99 (Table 1). The risk of progression to kidney failure increases with both increased predicted and measured ACR (Figure 1). Conclusion The results show that the models have discriminative power in all datasets. It predicts both micro- and macro-albuminuria with a PPV above 80% for the 25-quartile. However, classification performance is lacking in sensitivity, i.e., subjects suffering from albuminuria may not be classified as such. By using the median prediction of ACR we identify patient subpopulations that have a risk of kidney failure at least on par with the true ACR subpopulation targeted. This means that the method can be used confidently to identify at-risk individuals. Therefore, our model is advantageous in applications such as identifying undiagnosed albuminuria and pre-screening for clinical trials, where high PPV is more important than sensitivity. We intend to validate the model further for outcomes prediction in an upcoming CKD trial.

PROGRESSION OF HYPERTENSION-MEDIATED ORGAN DAMAGE IN PATIENTS WITH AND WITHOUT NONALCOHOLIC FATTY LIVER DISEASE

Objective: Nonalcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease and is associated with an increased risk of cardiovascular death. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening measure of hepatic steatosis. The purpose of the study was to compare the progression of hypertension-mediated organ damage (HMOD) in hypertensive patients with and without NAFLD. Design and method: Hypertensive patients (n = 60) without a history of cardiovascular disease participated in the study (mean age, 52 years; males, 55%; baseline clinic BP, 145/92 mmHg) and were followed for one year. In the baseline visit, FLI was calculated, and patients were divided into two groups by FLI below 60 or 60 or above (i.e., high-risk of NAFLD). All patients underwent clinic and 24-hour ambulatory BP measurements, echocardiographic examination, nailfold capillaroscopy, pulse wave velocity, and urinary albumin excretion assessment (albumin to creatinine ratio, [ACR]). Left ventricular mass index (LVMI) was also calculated using the Devereux formula. Results: In baseline visit, patients with FLI &gt; or = 60 (n = 32) compared to the control group had higher values of ACR (26.5±57mg/g vs. 9.6±6.3 mg/g, p = 0.02) and lower values of capillary densities (75±18cap/mm2 vs. 86±12cap/mm2, p = 0.002), whereas there was no relative difference in PWV and LVMI. At the end of follow-up, patients with FLI &gt; or = 60 had higher values of ACR (12.6±11.9 mg/g vs. 6.8±5.3 mg/g p = 0.025), PWV (9.9±2m/sec vs. 8.8±1.3 m/sec, p = 0.02), LVMI (81.4±13.2 g/m2 vs. 72.5±13.2 g/m2, p = 0.02) but lower number of capillaries (65.1±8.8 cap/mm2 vs. 79.6±7.5 cap/mm2, p&lt;0.001). Linear regression analysis revealed that FLI &gt; or = 60 was an independent determinant of follow-up ACR, PWV, LVMI, and the number of capillaries. Conclusions: Increased FLI may adversely modify the progression of HMOD in hypertension.

Associations of prematurity and low birth weight with blood pressure and kidney function in middle-aged participants of the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

An adverse intrauterine environment reflected by low birth weight (LBW) and prematurity may induce fetal programming that favors kidney dysfunction in adulthood. We examined the association of LBW and prematurity with blood pressure (BP) and kidney function markers in non-diabetic, middle-aged adults without kidney disease from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). A cross-sectional analysis of 768 subjects aged 35-54years was conducted. Comparisons were performed according to self-reported birth weight: LBW (< 2.5kg) or normal birth weight (2.5-4.0kg). Associations of LBW and prematurity with BP levels and kidney function markers "(estimated glomerular filtration rate [eGFR], albumin-creatinine ratio [ACR] and serum cystatin-C) were tested by multiple linear regression using adjustments based on Directed Acyclic Graphs. Propensity score matching was applied to control imbalances. Mean age of participants was 45.5 ± 4.6years and 56.8% were female; 64 (8.3%) participants reported LBW and 39 (5.0%) prematurity. The LBW group had higher systolic (p = 0.015) and diastolic BP (p = 0.014) and ACR values (p = 0.031) and lower eGFR (p = 0.015) than the normal birth weight group, but no group difference for cystatin-C was found. The preterm group had higher mean levels of systolic and diastolic BP, but no difference in kidney function markers was evident. In a regression model adjusted for sex, skin color and family history of hypertension, both systolic and diastolic BP levels were associated with LBW, but this association disappeared after adding forprematurity, which remained associated with BP (p = 0.017). Having applied apropensity score matching, LBW was associated with ACR values (p = 0.003), but not with eGFR or BP levels. The study findings of independent associations of prematurity with higher BP levels, and of LBW with markers of kidney function in adulthood, support that early life events maypredict risk for hypertension and kidney dysfunction in adulthood. The study design precluded the inferring of causality, and prospective studies are needed to further investigate this hypothesis.

ASSESSMENT OF ERYTHROPOIETIN STATUS IN EARLY DIABETIC NEPHROPATHY AND ITS CORRELATION WITH MICROALBUMINURIA

Objectives: To investigate serum Erythropoietin levels in patients with early diabetic nephropathy (&lt;5 years) and analyze the relationship between Erythropoietin and Microalbuminuria. Methods: Case population comprised of Type 2 diabetic patients in the age group 18-60 years with diabetes persisting for less than 5 years. Diagnostic criteria for case subject with diabetics was done as per ADA 2016 guidelines. A control group of healthy subjects was used for comparison. Results: Our study shows that Erythropoietin level is signicantly decreased in cases in comparison to controls (p value &lt;0.05). A negative correlation exists between Erythropoietin level and ACR value in cases and also a negative correlation exist between ACR and hemoglobin level in cases. Conclusion: Early Diabetic nephropathy is associated with decreased Erythropoietin level in spite of normal iron storage that warrant frequent monitoring among patients with diabetic kidney disease.

Correlation analysis of resected breast tissue and implant volume after mastectomy and its association with breast density

BackgroundThe current methods for calculating the ideal implant volume for breast reconstruction are based on pre- or intraoperative volume measurements of the existing breast volume and do not take into account the individual breast density of the woman. This study aims is to identify objective parameters that can help to improve the optimal implant selection.Materials and methodsThis retrospective analysis includes 198 breast cancer patients who underwent mastectomy. Breast densities (ACR) measured in mammography and MRI were compared with the removed breast tissue weight and volume of the implants used. In addition, the resected weight was compared directly with the implant volume to calculate a mathematical function.ResultsThere was no significant correlation between the ACR values and the resected weights [correlation coefficient: mammography:− 0.117 (p = 0.176), MRI − 0.033 (p = 0.756)]. A negative correlation between the implant volumes and both imaging methods could be demonstrated [correlation coefficient: mammography − 0.268; p = 0.002; MRI was − 0.200 (p = 0.055)]. A highly significant correlation between the resected weights and the implant volumes (correlation coefficient 0.744; p < 0.001) was observed. This correlation corresponds to a power function (y = 34.71 x0.39), in which any resected weight can be used for the variable x to calculate the implant volume.ConclusionWe were able to show that there is a significant correlation between the resected breast tissue and the implant volume. With our novel potency function, the appropriate implant volume can be calculated for any resected weight making it easier for the surgeon to choose a fitting implant in a simple and more objective manner.

Role of spot urine albumin-creatinine ratio in predicting pre-eclampsia between 20-28 weeks of gestation

Preeclampsia is best characterized as a condition unique to pregnancy that can affect almost any organ system. Appropriate treatment can be given and its effects can be closely monitored. The only widely recognized procedure remains the 24hour urine collection. However, the protracted time involved in sample collection to final reporting in this method, renders it impractical. The current research was therefore aimed at determining the accuracy of the spot urine ratio of albumin-creatinine in asymptomatic pregnant women. Appropriate treatment if started at early stage of the disease helps in closely monitoring of the disease process.A hospital based prospective, observational study was conducted with 150 patients to establish whether a spot urine albumin-creatinine ratio measured between 20-28 weeks gestation could predict pre-eclampsia in asymptomatic pregnant woman in Department of Obstetrics and Gynecology, Kalinga Institute of Medical Sciences and PBM Hospital, Bhubaneswar between September 2018 and April 2020.Of the study group, 28 patients had high ACR value, with 25(89.3%) developed pre-eclampsia and 3(2.4%) remained normotensive whereas among 122 (81.3%) patients that were ACR negative 3 (10.7%) patients developed pre-eclampsia. ACR had a sensitivity of 89.29%, specificity 97.54%, positive predictive value of 89.29% and the negative predictive value is 97.54%.Our analysis showed that in pre-eclampsia patients, urine albumin-creatinine ratio (UACR) values were higher and UACR &amp;#62;35.5 mg / mmol predicted pre-eclampsia well before clinical manifestations started. It is an easy, rapid and reasonably reliable method for predicting and assessing the severity of pre-eclampsia.

O19 A Complex Case of Systemic Lupus Erythematosus with Class IV Lupus Nephritis in a 15-year-old Egyptian Girl

O19 A Complex Case of Systemic Lupus Erythematosus with Class IV Lupus Nephritis in a 15-year-old Egyptian Girl

A GC-MS-Based Metabolomics Investigation of the Protective Effect of Liu-Wei-Di-Huang-Wan in Type 2 Diabetes Mellitus Mice.

Materials and Methods MKR mice were used for the development of diabetes with high-fat diet feeding. These mice were further injected with streptozocin (STZ) to aggravate kidney failure. Fasting blood glucose (FBG) and urinary albumin-to-creatinine ratio (ACR values) were determined to validate the successful establishment of diabetic models with desired kidney dysfunction. Metabolomics approach coupled with gas chromatography-mass spectrometry (GC-MS) and random forest (RF) algorithm was proposed to discover the metabolic differences among model group and control group as well as to examine the therapeutic efficacy of traditional Chinese medicine, Liu-Wei-Di-Huang-Wan (LWDHW), in diabetes and associated kidney failure. Results Some metabolites such as 3-hydroxybutyric acid, citric acid, hexadecanoic acid, and octadecanoic acid showed significant differences between the control group and model group. Treatment with LWDHW resulted in a significant decrease in FBG and ACR values. These results suggested that LWDHW could have beneficial effects in diabetes-associated renal failure.

P1002EFFECT OF VITAMIN D ON URINARY ANGIOTENSIOGEN LEVEL IN EARLY DIABETIC NEPHROPATHY

Abstract Background and Aims UrinaryAngiotensinogen (UAGT) is supposed to be a marker of activation of intrarenalreninangiotensin system (RAS) system in early Diabetic Nephropathy (DN). Vitamin D has been studied as a negative regulator of the circulating and tissue RAS activity; so its supplementation may prevent progression of DN. This study was planned to assess the RAS activation and effect of vitamin D supplementation in early diabetic nephropathy progression by estimatingUAGT level. Method A total of 730 Diabetic subjects were screened for early DN based on Inclusion criteria(eGFR ≥ 120ml/min/1.73m2 with unrestricted ACR value eGFR of 60- 120 mL/min/1.73m2 and ACR 30-300mg) and Exclusion criteria(on ACE I or ARB, eGFR&amp;lt;60ml/min/1.73m2, Hypercalcemia (&amp;gt;11.5mg%), UTI, Pregnancy, Hypertension, HbA1c (&amp;gt;8.0 %), vitamin D supplementation during the last 6 month).Of them 103 included subjects were underwent randomization to receive either Cholecalciferol(54) or matching Placebo(49) in a double blind method. All were subjected to routine investigations, urinary albumin: creatinine (UACR), UAGT, serum 25(OH)vitamin D, and intact parathyroid hormone (iPTH) at the zero and six months. A total 40 healthy controls without any comorbidity were also includedfor assessment of same investigations at zero month. Comparative results at zero months of all three groups were analyzed. Results The change in levels of UACR (mg/g), UAGT (ng/ml), vitamin D (ng/ml) and iPTH(pg/ml)in Cholecalciferol group from zero to six month were [Median (IQR)] : 12.50 (-24.82 to -5.95); p&amp;lt;0.001, -6.60 (-20.91 to -2.63);p&amp;lt;0.001, 5.75 (2.07-9.70); p&amp;lt;0.001, -5.35 (-11.55 to -3.67) ;p&amp;lt;0.001, respectively. After six months, median (IQR) of UAGT and UACR levels were significantly lower in the Cholecalciferol group as compared to Placebo group (p&amp;lt;0.001 and p= 0.04 respectively).Significant reduction of UACR (mg/g) and UAGT (ng/ml) level corroborating with increase in 25(OH) vitamin D(ng/ml) levelfrom zero to six months (all three p&amp;lt;0.001). There was significant correlation of vitamin D3 level with UAGT (r value: -0.255 &amp; p value: 0.009) and UACR level (r value: -0.28&amp; p value: &amp;lt;0.01). The median UAGT level was significantly higher in patients with early DN (Cholecalciferol&amp;Placebo Group) than Control Group at zero month (p =0.001). Conclusion Significantly higher UAGT levels in early DN supports role of intrarenal RAS activation. Significant decrease in UAGT level in cholecalciferol group supports beneficial role of vitamin D supplementation in progression of early DN.

MO049EFFECT OF VITAMIN D ON ENDOTHELIAL FUNCTION IN EARLY DIABETIC NEPHROPATHY

Abstract Background and Aims Diabetic Nephropathy is associated with endothelial dysfunction at an early stage. The benefit of Vitamin D supplementation on endothelial function is supported by a few studies in non-diabetic chronic kidney disease (CKD). However, studies on its effect in early DN is scarce. Hence, the present study was planned to assess the effect of vitamin D supplementation on endothelial function by measuring Flow mediated dilation (FMD) in patient of early DN. Method A total of 730 Diabetic subjects were screened for early DN based on Inclusion criteria (eGFR ≥ 120ml/min/1.73m2 with unrestricted ACR value eGFR of 60- 120 mL/min/1.73m2 and ACR 30-300mg) and Exclusion criteria (on ACE I or ARB, eGFR&amp;lt;60ml/min/1.73m2, Hypercalcemia (&amp;gt;11.5mg%), UTI, Pregnancy, Hypertension, HbA1c (&amp;gt;8.0 %), vitamin D supplementation during the last 6 month). Of them 103 included subjects were underwent randomization to receive either Cholecalciferol (54) or matching Placebo (49) in a double blind method. All were subjected to routine investigations, urinary albumin: creatinine (UACR), C reactive protein (CRP), serum 25(OH)vitamin D, intact parathyroid hormone (iPTH) and Flow mediated dilatation at the zero and six months. All subjects were subjected. Comparative results at zero and six months of both groups were compared and analyzed. Results There was no significant difference between cholecalciferol and placebo group with respect to CRP, iPTH, 25-hydroxyvitamin D (25(OH) D), UACR, FMD at baseline. Median FMD after 6 month was significantly higher in cholecalciferol as compared to placebo group [Median (IQR): 24 % (21.75-26.0) and 22% (18-24) respectively, p= 0.01]. After 6 month UACR was significantly lower in the cholecalciferol group as compared to placebo group (p= 0.04). Significant association of vitamin D level was observed with CRP level. In 25(OH) D &amp;lt; 20 ng/ml subgroup there was significant decrease in CRP level in comparison to 25(OH) D ≥20 ng/ml subgroup (p=0.04). Conclusion There was significant improvement in endothelial function as assessed by FMD% following vitamin D supplementation. Vitamin D supplementation given to early diabetic nephropathy patients may have favourable effects on cardiovascular outcome as reflected by improvement in FMD% and decrease in CRP level.

Albuminuria Regression and All-Cause Mortality among Insulin-Treated Patients with Type 2 Diabetes: Analysis of a Large UK Primary Care Cohort

Background: Overt albuminuria (urinary albumin-creatinine ratio [ACR] > 300 mg/g) is an established risk factor for progression of nephropathy and total mortality. However, whether a reduction in ACR translates into a reduction in mortality and/or cardiovascular (CV) events among insulin-treated patients with type 2 diabetes (T2D) in routine practice is currently not known. Methods: We obtained data on a large cohort of insulin users with T2D and nephropathy (baseline ACR ≥300 mg/g) from UK general practices between 2007 and 2014. Their corresponding ACR values after 1year of follow-up were thereafter categorized into: (1) < 300 mg/g (i.e., albuminuria regression) or (2) > 300 mg/g (i.e., nonregression of albuminuria), and the cohort was followed-up for 5 years for all-cause mortality and CV events. Cox proportional hazard models were fitted to estimate the risk of all-cause death. Results: A total of 11,074 patients with insulin-treated T2D met the inclusion criteria. Their mean age was 62.3 (13.6) years; mean HbA1c: 8.7 (1.8) and 53% were male. A total of 682 deaths occurred after a follow-up period of 43,393 person-years with a mortality rate of 16 per 1,000 person-years. Five-year survival was markedly reduced in the group whose proteinuria persisted or progressed (91 vs. 95%; log-rank p value < 0.001). Compared to patients whose ACR levels remained above 300 mg/g, all-cause mortality and CV events were 31 and 27% lower in those whose albuminuria regressed to < 300 mg/g (adjusted hazard ratio [aHR] 0.69; 95% CI 0.52–0.91; p = 0.008 and aHR 0. 73; 95% CI 0.54–0.98; p = 0.041), respectively. Conclusion: In patients with insulin-treated T2D and nephropathy in routine practice, a regression in albuminuria (e.g., via better BP or glycemic control) is associated with a significant reduction in all-cause mortality. Thus, albuminuria is not only simply a risk marker of renal and CV disease but also an independent target for therapy. Albuminuria reduction should be viewed as a goal for renal and CV protection.

Anti-albuminuric effects of spironolactone and its effect along with ramipril in type-2 diabetic nephropathy

Background: The study was conducted to evaluate and compare the protective effects of spironolactone (alone) and its effects along with ACE inhibitor (ramipril) on diabetics (30-70year) in relation to proteinuria and state of diabetic nephropathy.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70year) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Patients were divided in two groups, group A (n=28, spironolactone 25mg and ramipril 5mg) and group B (n=27, spironolactone 25mg). Subjects were followed over 12weeks and baseline and 12-week urine ACR being compared.Results: Both the group after receiving respective drug were followed for 3month duration and response were assessed by measuring urine ACR value at end of 3months. Mean values of baseline and follow up urine ACR for group A and group B were 471.5±465.62, 244.66±237.54 and 474.88±438.94, 268.42±268.16 respectively, P value found to be &gt;0.05 at 95%C.I. It was observed that percentage reduction of urine ACR were 48% and 43.47% in group A and group B respectively.Conclusions: In the study, it was concluded that spironolactone had significant effect over proteinuria reduction over follow up period in patient with diabetic nephropathy though there was no additional statistically significant advantage of addition of spironolactone and ACE inhibitor over proteinuria reduction. Significant reduction of proteinuria occurred in both group A and group B over 12weeks follow up period, 48 % reduction in group A and 43.47% in group B. This difference proved statistically not significant after applying independent t-test.

Factor determining the level of output in organic and inorganic farming in Nagapattinam district

This paper makes an attempt to analyse the factors determining per acre value of output under organic and conventional farming in Nagapattinam district. Further, it has taken into account the organic and inorganic farming under different sizes of land holdings viz., Marginal, Small, Medium and Large farms. Regarding selection of farm households, about 200 farm households have been selected and interviewed for the present study. Among them, 100 farm households are organic farming and the remaining 100 are inorganic farmers. It could be brought out from the conclusion of the study that, it may be brought out the major factors determining the per acre value of output under organic farming are animal labour, electricity, farmyard manure, panchakavya, amirtha karaisal, neem cake, neem oil green manure, and vermi compost. It showed that even one percent increase in use of these inputs lead to increase in per acre value of output under organic farming. Regarding inorganic farming, it could be revealed that human labour, animal labour, electricity, seed, farmyard manure, potassium and neem cake are the major factors determining the increase in per acre value of output in the study region.

Intravoxel incoherent motion (IVIM) at 3.0T: evaluation of early renal function changes in type 2 diabetic patients.

The purpose of this study was to evaluate the utility of intravoxel incoherent motion diffusion-weighted imaging (IVIM DWI) parameters in identifying early renal function changes in diabetics. A total of 40 patients with type 2 diabetes mellitus and 20 healthy control subjects underwent multiple b value DWI. The diabetic patients were stratified into two groups based on albuminuria category: NAU (normal to mildly increased albuminuria; ACR<30mg/g) and MAU (moderately increased albuminuria; 30≤ACR<300mg/g). The mean cortical and medullary IVIM parameters (D, D*, f, and ADC) were calculated and compared among the different groups, and the correlation of ACR and eGFR was also calculated. The present study revealed the limited water molecule diffusion and hyperperfusion of renal cortex and medulla in diabetic patients before proteinuria detection. Mean cortical and medullary D values negatively correlated with the ACR values in diabetics with 30≤ACR<300mg/g, whereas no correlation was found between ACR values and other IVIM parameters. IVIM DWI might be helpful in noninvasively identifying early-stage DN. The IVIM parametric values are more sensitive than the ACR in detecting early-stage kidney changes.

Finite Time Distributions of Stochastically Modeled Chemical Systems with Absolute Concentration Robustness

Recent research in both the experimental and mathematical communities has focused on biochemical interaction systems that satisfy an "absolute concentration robustness" (ACR) property. The ACR property was first discovered experimentally when, in a number of different systems, the concentrations of key system components at equilibrium were observed to be robust to the total concentration levels of the system. Followup mathematical work focused on deterministic models of biochemical systems and demonstrated how chemical reaction network theory can be utilized to explain this robustness. Later mathematical work focused on the behavior of this same class of reaction networks, though under the assumption that the dynamics were stochastic. Under the stochastic assumption, it was proven that the system will undergo an extinction event with a probability of one so long as the system is conservative, showing starkly different long-time behavior than in the deterministic setting. Here we consider a general class of stochastic models that intersects with the class of ACR systems studied previously. We consider a specific system scaling over compact time intervals and prove that in a limit of this scaling the distribution of the abundances of the ACR species converges to a certain product-form Poisson distribution whose mean is the ACR value of the deterministic model. This result is in agreement with recent conjectures pertaining to the behavior of ACR networks endowed with stochastic kinetics, and helps to resolve the conflicting theoretical results pertaining to deterministic and stochastic models in this setting.

Association of Albumin to Creatinine Ratio with Severity of Coronary Artery Disease

Coronary artery disease (CAD) is the most common cause of mortality and morbidity all over the world. It is also becoming a significant burden on healthcare service in Bangladesh. Atherosclerosis is the main pathology behind coronary artery disease. Endothelial dysfunction plays a crucial role in the process of atherosclerosis. Microalbuminuria (MA) is a reliable marker of endothelial dysfunction. This is why microalbuminuria is recognized as a simple marker of atherogenic milieu It was a cross sectional analytical study carried out in the department of Cardiology, Dhaka Medical College Hospital, Dhaka during the period of May, 2013 to April, 2014. After ethical consideration a total of 120 patients with IHD admitted in the department of Cardiology who fulfilled the inclusion and exclusion criteria and underwent coronary angiogram were taken as sampling population by purposive sampling. 1st morning spot urine sample was taken for measurement of ACR.Microalbumnuria was measured by rate nephelometry using Behring protein analyzer. All the study subjects were placed into two groups according to ACR value (group I- positive urinary ACR &gt;30 mg/g &amp; group II-Normal urinary ACR &lt;30 mg/g). Angiographic severity of coronary artery disease was assessed by vessel score and stenosis score. Age and sex distribution of the subjects in two groups with MA and without MA were similar. No significant difference was observed between two groups with regard to smoking, dyslipidaemia, hypertension and family history of IHD. Prevalence of diabetes mellitus was significantly more in subjects with MA than without MA (60% vs 33.9%, p=0.006). All 40 patients of group I had significant CAD. 57(71.2%) patients of group II had significant CAD and 23(28.8%) patients had no significant CAD. The difference was highly significant (p&lt;0.001). Single vessel involvement was significantly more frequent in subjects of group II than group I (35.0% vs15.0%, p=0.022) Double vessel involvement was more in group I than group II, but the difference was not statistically significant (36.8% vs 32.40%,p=0.641).Triple vessel involvement was significantly more frequent in subjects of group I than group II (50.0% vs10.7%, p&lt;0.001). The mean stenosis score of group I was significantly higher than group II (95% CI 4.966 to 2.809, p&lt;0.001). The mean ±SD total coronary vessel score of group I was 16.60±4.75 with a range of 7.0-21.0 and mean ±SD total coronary vessel score of group II was 8.26±6.24 with a range of 0.0-21.0. The mean total score of group I wassignificantly higher than group II (95% CI 10.558 to 6.117, p&lt;0.001). Patient with microalbuminuria has more extensive and complex angiographic coronary artery disease compared to those without microalbuminuria.University Heart Journal Vol. 10, No. 1, January 2014; 18-22

(143) - Donor- and Recipient-Related Predictors of Mortality After Heart Transplantation: Results From a Contemporary French National Cohort

s S61 Methods: 117 patients undergoing HTx at IKEM were prospectively enrolled. AKI was defined as an increase of serum creatinine level by ≥ 50% or worsening of renal function requiring renal replacement therapy (RRT) during 1st week postHTx. Serum Cystatin-C and urinary Neutrophil gelatinase-associated lipocalin (NGAL), alpha-1-microglobulin (A1M) or albumin were serially sampled. Results: 30 patients (25.6% of total) fulfilled the criteria of AKI. Preoperative renal function, demographics and comorbidities were similar between AKI and non-AKI groups. Cystatin-C displayed earliest and the most robust separation between AKI and non-AKI group, with significant difference present already 3 hours after surgery (figure left, arrow) and persisting on day 7 and 10. The increase in Cystatin-C preceded the serum creatinine elevation by 4 days. In univariate analysis, Cystatin-C> 1.6 mg/L at 3-hours after HTx predicted AKI with OR 5.1 (95%CI: 2.2-13) and in multivariate analysis (adjustment to presence of sepsis, bleeding or need of RVAD) with OR 4.4 (95% CI:1.7-12). Urinary NGAL raised significantly only on day 3 in AKI group (p= 0.003). Differences in ACR and A1M values between groups did not reach significance. Interestingly, elevated Cystatin-C (≥ 2.5mg/L at day 7) predicted also long-term mortality after HTx (figure right). Conclusion: Cystatin-C was the most useful for evaluation and prediction of AKI. Measurement of serum Cystatin-C in patients early after HTx (3h after surgery) may help to promptly identify the patients with high risk for renal complications. Elevated cystatin-C also predicts long-term outcome. (Grant NT/11269 5 and NT/ 11262-6 and Institutional support 00023001) ascending aortic diameter was also a predictor and may reflect the risks associated with an undersized allograft. The final predictor was total ischemic time emphasizing the need for improvements in allograft preservation and storage.

Microalbuminuria: a biomarker of sepsis and efficacy of treatment in patients admitted to a medical intensive care unit of a tertiary referral center.

The outcome of sepsis is significantly affected by early institution of goal-directed therapies and hence, the search for an early marker of sepsis continues. To observe microalbuminuria levels between patients with sepsis and those without sepsis s admitted to the medical intensive care unit (MICU) of a tertiary referral centre (primary) as also to assess the change in microalbuminuria levels in the first 24 hours as a predictor of mortality and morbidity relative to the APACHE II and SOFA scores. This was a prospective observational study where 125 patients with sepsis and 38 without were assessed. Trend of microalbuminuria was assessed from the change of ACR value within 6 hours of admission (ACR1) to the ACR value at 24 hours (ACR2) in both groups of patients. Significantly higher levels of microalbuminuria were found among patients with sepsis as compared to those without sepsis. The levels decreased in survivors with sepsis after 24 hours, whereas they continued to remain almost at the same levels among those without sepsis. The change in microalbuminuria levels over 24 hours can be used to measure the effectiveness of therapy. Persistence of high levels or increasing trend of microalbuminuria levels over 24 hours was found to be a predictor of a poor outcome. A high level of microalbuminuria at 24 hours and increasing trend of microalbuminuria also predicted mortality better than APACHE II and SOFA scores.