Alb Ratio Research Articles

Serum albumin redox state as an indicator of dietary protein intake among community-dwelling older adults

Background and AimsSerum markers capable of detecting mild levels of undernutrition, such as insufficient dietary protein intake (IDPI), have not been established among community-dwelling older adults. Although the serum albumin redox state, expressed as the ratio of reduced albumin (Alb) to total Alb (the reduced albumin ratio), has the potential to overcome this challenge, empirical epidemiological data are lacking. This study aimed to investigate the association between a serum reduced Alb ratio and dietary protein intake among community-dwelling older adults. MethodsThis study analyzed cross-sectional data from 1,005 community dwelling older people (572 males and 433 females) aged 70–84 years who participated in the Itabashi Longitudinal Study on Aging. Exclusion criteria included participants with incomplete data, individuals with a history of kidney disease and high C-reactive protein (CRP) levels. The dietary protein intake was estimated using validated food frequency questionnaires. The IDPI was defined as not meeting the level recommended by the Dietary Reference Intakes for Japanese (Men ≥60g/day, Women ≥50g/day). ResultsIDPI was observed in 14.1% of the study population. Logistic regression analyses adjusted for sex, age, body weight and malnutrition showed that a serum reduced Alb ratio was significantly associated with IDPI (odds ratio = 0.962, 95% confidence interval = 0.926–0.999) , whereas serum albumin concentration was not (odds ratio = 0.549, 95% confidence interval = 0.285–1.061). ConclusionsA serum reduced Alb ratio would be a useful indicator of protein insufficiency among community-dwelling older adults.

Albumin change predicts failure in ulcerative colitis treated with adalimumab.

Anti-tumor necrosis factor (TNF) -α antibodies, including infliximab (IFX), adalimumab (ADA), and golimumab, which were the first biologic therapeutic agents, have a crucial position in advanced therapy for ulcerative colitis (UC). We aimed to investigate serum albumin (Alb) change as a prognostic factor for the therapeutic effect of ADA in UC. Thirty-four patients with UC treated with ADA were enrolled in this study and were divided into failure and non-failure groups. Biological data, such as Alb were compared between the two groups. Thirteen patients showed failure within six months. Examination of the biological data showed a significant difference between the two groups only in the week 2/week 0 Alb ratio. In receiver-operating characteristic (ROC) curve analysis to predict failure, the cut-off value of week 2/week 0 Alb ratio was 1.00, and the area under the curve was 0.868 (95% confidence interval: 0.738-0.999). In addition, in the sub-group analysis of only clinically active patients, the week 2/week 0 Alb ratio of the non-failure group was significantly higher than that of the failure group, and the cut-off-value in ROC analysis was 1.00. Week 2/week 0 Alb ratio ≤ 1 predicts failure within six months of ADA for UC.

Features of liver injury in 138 Chinese patients with NICCD.

To find biochemical and molecular markers can assist in identifying serious liver damage of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) patients. 138 patients under 13days to 1.1 year old diagnosed of NICCD in our center from 2004 to 2020. Base on the abnormal liver laboratory tests, we divided 138 patients into three groups: acute liver failure (ALF), liver dysfunction, and non-liver dysfunction groups, then compared their clinical, biochemical and, molecular data. 96 % of 138 patients had high levels of citrulline and high ratio of threonine to serine, which is the distinctive feature of plasma amino acid profile for NICCD. A total of 18.1 % of 138 patients had evidence of ALF who presented the most severity hepatic damage, 51.5 % had liver dysfunction, and the remaining 30.4 % presented mild clinical symptoms (non-liver dysfunction). In ALF group, the levels of citrulline, tyrosine, TBIL, ALP, and γ-GT was significantly elevated, and the level of ALB and Fisher ratio was pronounced low. Homozygous mutations of 1,638_1660dup, IVS6+5G.A, or IVS16ins3kb in SLC25A13 gene were only found in ALF and liver dysfunction groups. Supportive treatment including medium-chain triglyceride supplemented diet and fresh frozen plasma could be life-saving and might reverse ALF. High level of citrulline, tyrosine, TBIL, ALP, γ-GT, and ammonia, low level of albumin, and low Fisher ratio were predictors to suggest severe liver damage in NICCD patients who may go on to develop fatal metabolic disorder. Early identification and proper therapy is particularly important for these patients.

A lower ratio of reduced to total albumin in serum is associated with protein nutritional status of pregnant women in Japan

Protein-energy undernutrition is potentially prevalent among Japanese pregnant women, and biomarkers that objectively indicate the protein nutritional status during pregnancy may help in implementing appropriate protein supplementation to these women. We hypothesized that a serum parameter of pregnant women, the ratio of reduced to total albumin (reduced ALB ratio), would be associated with protein intake during pregnancy. The serum reduced ALB ratio of pregnant women was compared with protein intake and with gestation outcomes (gestation length and infant birth weight) in an observational study of 115 Japanese pregnant women. The serum reduced ALB ratio in the third trimester tended to be positively correlated with gestation length (P = .07). Infant birth weights tended to be different between protein intake tertiles (P = .09); the mean infant birth weight was higher in the third tertile compared with the first and second tertiles. The protein intake of pregnant women was significantly and positively correlated with the serum reduced ALB ratio in the second trimester. The serum reduced ALB ratio reflects protein nutritional status during pregnancy and may contribute to healthier gestation outcomes.

Clinical Features and Prognosis of Severe Secondary Hyperparathyroidism: A Retrospective Study from a Single Center

PurposeSecondary hyperparathyroidism (SHPT) is one of the most common complications of chronic kidney disease and has a high rate of morbidity and mortality. Current studies on prognostic factors in SHPT are inadequate. We aimed to identify a single-center cohort of severe SHPT to elucidate relevant clinical and laboratory features and explore laboratory indicators that related to its prognosis.MethodsThe clinical data of 46 patients with SHPT, admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Zhengzhou University in the time period ranging from January 2019 to March 2022 were analyzed retrospectively. Clinical data collected were screened univariately for influences that were associated with poor prognosis. A binary logistic regression model was constructed to analyze the independent risk factors for poor clinical prognosis, using correlated influences. The value of each indicator in predicting patient prognosis was analyzed using receiver operating characteristic curves (ROC) curves.ResultsThe causes of death among the 46 patients with severe SHPT were cardiogenic death (malignant arrhythmia, cardiac arrest) in 11 cases (47.8%), sepsis in 9 cases (39.2%), and neurogenic death (intracranial hemorrhage) in 3 cases (13.0%). Patients were divided into a good prognosis group and a poor prognosis group according to their status at the time of leaving the ICU. There was no statistically significant difference in sex, BUN, NT-pro BNP, ALP, Scr, Mg, Ca, Pi, K, CRP, Hb, and PLT between the poor prognosis group and the good prognosis groups. The age, PTH, PCT, WBC, APACHE II, and neutrophil ratio of the poor prognosis group were higher than those of the good prognosis group, and the ALB level was lower than that of the good prognosis group, with a statistically significant difference of P < 0.05. The 19 clinical indicators mentioned above were screened univariately. Among them, age, PTH, WBC, ALB, APACHE II and neutrophil ratio were significantly associated with prognosis, P < 0.05. Binary logistic regression analysis showed that age (OR = 1.076, 95% CI (1.011, 1.145)), PTH (OR = 1.004, 95% CI (1.000, 1.007)), WBC (OR = 1.295, 95% CI (1.026, 1.634)) were indicators for poor prognosis in patients with severe SHPT, and ALB (OR = 0.803, 95% CI (0.645, 0.998)) was a protective factor for poor prognosis. The ROC curve showed that the optimal cut-off point for patient age was 51 years, with a sensitivity of 86.9% and specificity of 52.2%; the optimal cut-off point for PTH was 346 pg/ml, with a sensitivity of 59.1% and specificity of 82.6%; the optimal cut-off point for WBC was 11.95 × 10^9/L, with a sensitivity of 56.52% and specificity of 91.3%; the optimal cut-off point for neutrophil ratio was 82.4%, sensitivity 82.6%, specificity 73.9%.ConclusionAge, PTH, and WBC are independent risk factors for poor prognosis of severe SHPT, and ALB is an independent protective factor for poor prognosis. Patients with severe SHPT should be assessed for risk of the poor prognosis based on age, admission PTH, WBC, ALB, and neutrophil ratio as early as possible to adjust the treatment strategy.

Serum indoxyl sulphate and its relation to albumin and α1-acid glycoprotein as a potential biomarkers of maternal intestinal metabolism during pregnancy and postpartum.

BackgroundSerum indoxyl sulfate (IS) levels depend on the production of indole in the gut. The biological effects of IS in the vascular bed could be confirmed by changes in the levels of individual serum proteins during normal pregnancy and in the postpartum period as compared with non-pregnant controls. Albumin (Alb) and α1-acid glycoprotein (AGP, orosomucoid) are the most abundant serum carrier proteins with potential interrelationships with serum levels of IS.MethodsSerum levels of IS, Alb and AGP were measured in 84 pregnant women in the first, second and third trimester of pregnancy and in the postpartum period, as well as in non-pregnant controls (n = 20), using ultra-performance liquid chromatography (UPLC) coupled to mass spectrometry (IS), colorimetric assay (Alb) and immunoturbidimetric assay (AGP).ResultsThe postpartum serum levels [mg/L] of IS were lower (p = 0.027) than in the second trimester (mean±SD: 0.85±0.39 vs 0.58±0.32). There were no differences in the IS to ALB ratio calculated in the three trimesters of pregnancy, the postpartum period, and in the non-pregnant controls. The IS/AGP ratio increased from the first to the second trimester (p = 0.039), and decreased in the postpartum period (p<0.05), when it was lower than in the second and third trimester.ConclusionsThe variability of the serum IS/AGP ratio during pregnancy and in the postpartum period may reflect shared involvement in the regulation of their intravascular relationships. The link between serum levels of IS derived from the gut and AGP could serve a potential biomarkers of maternal intestinal metabolism during pregnancy and postpartum.

Early serum albumin changes in patients with ulcerative colitis treated with tacrolimus will predict clinical outcome.

BACKGROUNDOral tacrolimus is a therapeutic agent for moderate to severe steroid-dependent or resistant ulcerative colitis (UC), but remission induction is difficult, and it is necessary to treat the patient while considering the next treatment.AIMTo examine serum albumin (Alb) level as a prognostic factor for the therapeutic effect of tacrolimus in clinical practice.METHODSForty-seven patients with UC treated with tacrolimus at our institution were divided into remission and failure groups (colectomy or switch to biologics), and the biological data at the start of observation and at weeks 1 and 2 were retrospectively examined. Kaplan-Meier and multivariate analyses were performed using Alb as a prognostic factor in UC treatment.RESULTSDuring the three months observed, 17 (36.2%) patients failed treatment with tacrolimus. A comparison between the failure and remission groups showed a significant difference only in Alb in week 2, and in the week 2/week 0 Alb ratio, which showed the rate of change in Alb. The cut-off value of the week 2/week 0 Alb ratio that predicted failure was 1, and its area under the curve was 0.751 (95%CI: 0.604-0.898). In the Kaplan-Meier analysis, a week 2/week 0 Alb ratio ≤ 1 had a significantly higher failure rate than that of > 1; Cox proportional hazard regression analysis also showed that a week 2/week 0 Alb ratio ≤ 1 was an independent prognostic factor for failure within 3 mo after the start of tacrolimus treatment.CONCLUSIONA week 2/week 0 Alb ratio ≤ 1 predicts failure within 3 mo of tacrolimus administration for UC. High failure risk exists with week 2 Alb values ≤ 1 on admission.

Age, Sex, and BMI Influence on Copper, Zinc, and Their Major Serum Carrier Proteins in a Large European Population Including Nonagenarian Offspring From MARK-AGE Study.

The analysis of copper (Cu) and zinc (Zn) along with their major serum carriers, albumin (Alb) and ceruloplasmin (Cp), could provide information on the capacity of humans to maintain homeostasis of metals (metallostasis). However, their relationship with aging, sex, body mass index, as well as with nutritional and inflammatory markers was never investigated in a large-scale study. Here, we report results from the European large-scale cross-sectional study MARK-AGE in which Cu, Zn, Alb, Cp, as well as nutritional and inflammatory parameters were determined in 2424 age-stratified participants (35-75 years), including the general population (RASIG), nonagenarian offspring (GO), a well-studied genetic model of longevity, and spouses of GO (SGO). In RASIG, Cu to Zn ratio and Cp to Alb ratio were higher in women than in men. Both ratios increased with aging because Cu and Cp increased and Alb and Zn decreased. Cu, Zn, Alb, and Cp were found associated with several inflammatory as well as nutritional biomarkers. GO showed higher Zn levels and higher Zn to Alb ratio compared to RASIG, but we did not observe significant differences with SGO, likely as a consequence of the low sample size of SGO and the shared environment. Our results show that aging, sex, body mass index, and GO status are characterized by different levels of Cu, Zn, and their serum carrier proteins. These data and their relationship with inflammatory biomarkers support the concept that loss of metallostasis is a characteristic of inflammaging.

Chronotherapy with a Renin-angiotensin System Inhibitor Ameliorates Renal Damage by Suppressing Intrarenal Renin-angiotensin System Activation.

Objective The intrarenal renin-angiotensin system (RAS) is activated in chronic kidney disease (CKD) patients and is not suppressed at night in CKD patients showing nocturnal hypertension, contributing to renal damage. Furthermore, changes in RAS inhibitor administration from morning to evening, namely chronotherapy, ameliorates renal damage at night. We attempted to clarify whether or not chronotherapy ameliorates renal damage by suppressing the intrarenal RAS activity. Methods We recruited 34 CKD patients with RAS inhibitors in the morning. We conducted ambulatory blood pressure (BP) monitoring and urine collection and evaluated urinary albumin (Alb) and angiotensinogen (AGT), which are surrogate markers for intrarenal RAS activity during the day and at night, respectively. The same experiments were conducted after changing the administration time. The ratio of values associated with morning versus evening dosing was defined as the morning to evening (M/E) ratio. Results The M/E ratio of urinary Alb had a significant and positive relationship with that of urinary AGT during the day and at night in all CKD patients. However, no significant relationships were found between the M/E ratios of urinary Alb and AGT using multiple linear regression analyses. Conversely, there was a significant and positive relationship between the M/E ratios of urinary Alb and AGT at night but not during the day in CKD patients whose estimated glomerular filtration rate was <45 mL/min/1.73 m2 and whose night-to-day ratio of systolic BP was >0.90, even after adjustment. Conclusion This study indicated that chronotherapy with RAS inhibitors improved the renal damage via intrarenal RAS suppression, especially in CKD patients with an impaired renal function and nocturnal hypertension.

P1567THE ANNUAL VARIATION OF CRA/ALBUMIN RATIO IS AN ACCURATE PROGNOSTIC FACTOR IN DIALYSIS PATIENTS

Abstract Background and Aims Protein energy wasting (PEW) is a distinctive malnutrition status in hemodialysis(HD) patients, and it is closely related to poor prognosis. We previously reported that CRP/Alb ratio is useful marker for assessment of malnutrition status in HD patients. However, the value of CRP/Alb ratio calculated by CRP and serum albumin level is considered to be varied over time, and correlation between the amount of change and the prognosis is uncertain. The purpose of this study is to investigate the effect of the changing in CRP/Alb ratio within a certain period of time on prognosis of dialysis patient. Method 320 patients who were received stable dialysis therapy were enrolled in the study. It was analyzed that the relation between the changing in CRP/Alb ratio within one year and the prognosis. Furthermore, patients were divided by the values of CRP/Alb (&amp;gt;0.35) and ΔCRP/Alb ratio (&amp;gt;0.05) as a threshold (4 groups of 2 × 2), and analyzed for the prognostic value. Results During the observation period (median 71 months), 138 patients were died (43.1%). Baseline CRP/albumin ratio, both of continuous value and cut-off value of 0.34 as median, was identified as an independent predictor for 7-year mortality. The CRP / Alb ratio at one year increased from 0.40 (0.46-1.7) to 0.47 (0.22-1.48) (p = 0.0040). The 7-year survival rate was 44.7% in the group with increased ΔCRP / Alb ratio and 57.0% in the group with non-increased (p = 0.020). The adjusted hazard ratio was 1.45 (95% CI 1.02-2.06, p = 0.037, increase group vs non-increase group). On combined setting of each predictors, mortality risk was clearly stratified, and patients with high and increased CRP/albumin ratio had 2.84-fold (95%CI 1.65-5.03) higher risk of mortality compared to patients with low and no-increased CRP/albumin ratio Conclusion The increasing rate of CRP/Alb ratio were strong predictors of mortality as well as the baseline CRP/Alb ratio levels, and both of them additively improved the predictability for mortality in chronic HD patients.

Correlation between C-reactive protein/albumin and contralateral hip refracture after total hip arthroplasty in elderly patients with hip fractures.

There is still a risk of refracture of the contralateral hip after total hip replacement, to analyze the expression of C-reactive protein (CRP) and albumin (Alb) in elderly patients with contralateral hip refracture after total hip arthroplasty (THA), and to determine its correlation with the risk of post-surgery refracture and guide the prediction of the risk of contralateral hip fracture in the future. The medical records of elderly patients who suffered hip fracture and underwent THA at our hospital between July 2016 and July 2019 were reviewed, and 224 eligible patients were finally enrolled. The patients were divided into the refracture group and the control group according to the incidence of contralateral hip refracture. The baseline data of the two groups were compared, and all relevant laboratory tests were performed before surgery. The serum levels of CRP and Alb were compared, along with the CRP/ Alb ratio, between the two groups to establish whether CRP/Alb is a predictor for post-surgery contralateral hip refracture in elderly patients. Twenty (8.93%) of the 224 patients suffered post-surgery contralateral hip refracture. There were no significant differences in the baseline data of the refracture and control groups (P>0.05). However, the patients who experienced refracture had significantly higher CRP levels and lower Alb levels compared with the controls, resulting in an elevated CRP/Alb ratio in the patients with refracture (P<0.05). Serum CRP level was negatively correlated to that of Alb (r=-0.443, P<0.001). The linear regression equation was Y=2.718-0.598X, indicating that the CRP/Alb ratio is a risk factor for contralateral hip refracture in elderly hip fracture patients following THA (P<0.05). The area under the receiver operating characteristic (ROC) curve of the CRP/Alb ratio as a predictor for post-THA contralateral hip refracture was 0.841 (95% CI: 0.702-0.914). The optimal cutoff value was 1.12, which corresponded to high specificity and sensitivity of 0.782 and 0.945, respectively, and the Youden index was 0.727. Serum CRP level is closely associated with Alb level in elderly hip fracture patients, and the CRP/Alb ratio is a risk factor for post-THA contralateral hip refracture. Therefore, preoperative measurement of serum CRP/Alb level can assist with predicting the risk of post-THA refracture in elderly hip fracture patients.

Serum protein levels and albumin/globulin ratio in patients with uterus, ovary, and breast tumors compared to healthy women in Kirkuk City

Background: Gynecological cancer is one of the most serious public health problems in the world with main gynecological cancers, uterus, breast, and ovarian, causing morbidity with severe suffering and a high mortality. Objective: This study aimed to investigate the levels of the total protein (TP), albumin (Alb), globulin (Glo), and Alb/Glo ratio in the female patients with (uterus, ovary, and breast) cancer compared to healthy females. Materials and Methods: This study included 120 females with (28 uteri, 31 ovaries, and 25 breasts) cancer patients and 36 healthy control participants, with age ranges between (20 and 42) years. Results: Alb levels significantly (P ≤ 0.05) decreased in all patient samples except those with uterus cancer who showed significant increase (P ≤ 0.05) compared to healthy participants, and Glo levels significantly (P ≤ 0.05) decreased for uterus and breast cancer samples and nonsignificant (P ≤ 0.05) decrease in patients with ovary cancer compared to healthy participants; finally, the ratio of Alb./Glo. showed significant (P ≤ 0.05) decrease in all patients group except patients with breast cancer showed significant increase (P ≤ 0.05) compared to healthy participants. The results of correlation coefficient indicated that there were significant (P ≤ 0.05) positive correlations between TP and Glo for uterus and breast cancer patients and between TP and Alb for ovary cancer patients. Conclusion: The ratio of Alb/Glo was significantly (P ≤ 0.05) decreased in all patients group except patients with breast cancer who showed significant increase (P ≤ 0.05) compared to healthy participants which could be used in the diagnosis of these patients.

Abstract 3239: Molecular biomarkers and indoor household air pollution in a rural area of China

Abstract To explore the influence of fuel source used for home heating and cooking on biomarkers of potential genomic instability, we analyzed biological samples obtained from a cross-sectional study of 104 female never-smokers enrolled from 30 villages in Xuanwei and Fuyuan in Yunnan Province, a rural region with a high incidence of lung cancer in China. Study subjects who used primarily smoky (i.e., bituminous) coal (n=80), smokeless coal (i.e., anthracite) (n=14) and wood (n=10) were analyzed. Personal 24-h air PM2.5 and polycyclic aromatic hydrocarbon concentrations were measured over two consecutive days in each household. DNA was extracted from peripheral white blood cells. We assayed molecular biomarkers of potential genomic instability including the Alu copy number to albumin gene (ALB) ratio (Alu/ALB), 5.8S ribosomal DNA to ALB ratio (5.8S rDNA/ALB) and 18S ribosomal DNA to ALB ratio (18S rDNA/ALB), which were weakly to highly correlated with each other. Multiple linear regression was performed to analyze the association between fuel type and these biomarkers, adjusted for age, as well as the influence of benzo[a]pyrene (BaP) and PM2.5 concentration. There was a significant difference (p = 0.041) in levels of 18S rDNA/ALB among the three exposure groups [mean (standard deviation [sd]) = 1.30 (0.42), 1.58 (0.72), and 1.65 (0.62) among smoky, smokeless coal and wood users, respectively]. There were substantial differences in personal PM2.5 exposure among smoky coal, smokeless coal, and wood users [mean (sd) =184 (127), 227 (318), and 433 (284) µg/m3, respectively, p = 0.0004]. PM2.5 exposure was significantly and positively associated with 18S rDNA/ALB (p = 0.001). Further, after adjustment for PM2.5, the association between fuel type and 18S rDNA/ALB became non-significant (p = 0.24). Similar positive associations were observed between PM2.5 and 5.8S rDNA/ALB (p=0.009) and Alu/ALB (p=0.0003). There were no associations identified between BaP and these biomarkers after adjustment for PM2.5. Our findings suggest that exposure to PM2.5, which has been associated with increased risks of lung cancer and cardiovascular disease, may alter potential molecular markers of genomic instability. Additional studies are needed to confirm these findings and further understand the role of these biomarkers in predicting human health effects. Citation Format: Wei Hu, Richard M. Cawthon, George Downward, Boris Reiss, Jihua Li, Jun He, Jun Xu, Wei Jie Seow, Bryan A. Bassig, Jason Y. Wong, Dean Hosgood, Lützen Portengen, Nathaniel Rothman, Roel Vermeulen, Qing Lan. Molecular biomarkers and indoor household air pollution in a rural area of China [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3239.

Characteristics of Patients and Their Ascites Who Underwent Repeated Cell-Free and Concentrated Ascites Reinfusion Therapy.

Novel cell-free and concentrated ascites reinfusion therapy (KM-CART) is easy to use, safe and applicable for refractory ascites. We can get the full amount of ascites, filtrate, and concentrate in a short time. KM-CART can be applied as palliative care for dying patients including patients with massive malignant ascites. Some patients who underwent repeated KM-CART survived longer than those who did not repeat the therapy. The aim of this study was to identify the type of patients with ascites for whom KM-CART would be effective and candidates for repeated KM-CART. In this retrospective cohort observational study, we examined 123 CART processes performed on 58 patients with refractory ascites. Data were collected before and after processing of the ascites. We compared two groups; patients who underwent KM-CART ≥ 5 times and those who underwent this process ≤ 4 times. Age, disease, benign or malignant status of the disease, the amount of ascites, concentrations of total protein (TP) and albumin (Alb) and their amounts in the original ascites and the filtered and concentrated ascitic fluid and the recovery ratio of TP and Alb were determined. No significant difference was observed between the two groups in age, disease, amount of ascites, and the recovery ratio of TP and Alb. Significant differences were observed in the amounts of TP and Alb in the original ascites and the filtered and concentrated ascitic fluid. Patients who underwent KM-CART ≥ 5 times had higher Alb levels in the original ascites than those who underwent this therapy ≤ 4 times. Patients with higher Alb concentrations in the original ascites could be candidates for repeated KM-CART.

Sleep disorders and its related risk factors in patients undergoing chronic peritoneal dialysis

Background The prevalence of sleep disorders has been shown to be high in patients with chronic dialysis patients and may contribute to impaired quality of life and higher mortality in this population. However, there are few data on the relationship of sleep disorders and their risk factors in chronic dialysis patients. The aim of this study was to evaluate the relationship of sleep disorders and their risk factors in chronic dialysis patients. Methods A total of 42 continuous ambulatory peritoneal dialysis (CAPD) patients were involved in this cross-sectional study. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Restless legs syndrome (RLS) was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group. And depression was assessed by Hamilton depression scale. General information and laboratory data were collected. Results The prevalence of sleep disorders was 47.6% in the CAPD patients. According to the PSQI, the 42 CAPD patients were divided into sleep disturbance group and non-sleep disorders group. There were no significant differences in age, gender, dialysis duration, hemoglobin, serum creatinine, urea nitrogen, β2-microglobulin, parathyroid hormone, calcium, and phosphorus between CAPD patients with sleep disorders and those without sleep disorders. But the level of serum albumin (Alb) in CAPD patients with sleep disorders was significantly lower than that in CAPD patients without sleep disorders (31.3±1.4 vs. 34.3±3.7, t=3.603, P=0.001). And the prevalence of RLS and depression was significantly higher than that in CAPD patients without sleep disorders (RLS: 11/22 vs. 1/20, χ2=10.395, P=0.001; depression: 7/22 vs. 1/20, χ2=4.886, P=0.027). In CAPD patients with RLS, the prevalence of sleep disorders was significantly higher than that in CAPD patients without RLS (11/22 vs. 11/30, χ2=10.395, P=0.001). And in CAPD patients with depression, the prevalence of sleep disorders was significantly higher than that in CAPD patients without depression (7/8 vs. 15/34, χ2=4.886, P=0.027). In CAPD patients, bivariate correlation analysis showed that sleep disorders was negatively correlated with serum Alb (r= -0.606, P=0.000) and positively correlated with RLS (r=0.497, P=0.001) and depression (r=0.341, P=0.029). Multivariate regression analysis revealed that the odds ratio of RLS, depression, and low serum Alb was 22.900, 42.209, and 0.597, respectively. Conclusions The prevalence of sleep disorders was relatively high in CAPD patients. RLS, depression, and low serum Alb were the risk factors for CAPD patients with sleep disorders.

Relationship between nutritional depletion and cell-mediated immune function in active pulmonary tuberculosis

A survey on the nutritional status and cell-mediated immune function of 47 hospitalized patients with active pulmonary tuberculosis and healthy controls was conducted. In the patients group: 1) Anthropometric measurements, such as %ideal body weight (%IBW), %arm circumference (%AC), %arm muscle circumference (%AMC) and %triceps skin fold (%TSF), were significantly reduced. 2) Visceral proteins including serum albumin (Alb), transferrin (Tf), prealbumin (PA) and retinol binding protein (RBP) were significantly reduced. 3) The imbalance of plasma amino acids, which was characterized by the depression of Fischer ratio, a molar ratio of branched chain amino acids (BCAA) to aromatic amino acids (AAA), was observed. Fischer ratio was significantly correlated with anthropometric measurements (%IBW, %AC and %AMC). Delayed-type hypersensitivity to DNCB (2,4-dinitrochlorobenzene) and lymphocyte transformation to phytohemagglutinin (PHA) and concanavalin A (Con A) were significantly impaired in the patients group, whereas NK cell activity was higher than that of controls. Alb, PA, RBP and Fischer ratio were significantly lower in the patients with reduced DNCB reaction than in those with normal responses. Lymphocyte transformation was significantly correlated with Fischer ratio, and NK cell activity was significantly correlated with Alb, PA, RBP. These data may suggest that the imbalance of plasma amino acids represented by the reduction of Fischer ratio and the depletion of visceral proteins are closely related to the impairment of lymphocyte function in the patients with active pulmonary tuberculosis.

Influence of the Dialysis Membrane on Markers of Tissue Ischemia

BackgroundHemodialysis (HD) is often accompanied by adverse effects, such as tissue ischemia. We have already observed an increase in plasma adenosine (ADO) levels during HD sessions, which may be the...

Effects of growth light and nitrogen nutrition on the organization of the photosynthetic apparatus in leaves of a C4 plant, Amaranthus cruentus

Properties of C4 photosynthesis were examined in Amaranthus cruentus L. (NAD-malic enzyme (ME) subtype, dicot) grown under different light and nitrogen (N) conditions, from the viewpoint of N investment into their photosynthetic components. In low-light (LL) leaves, chlorophyll content per leaf area was greater and chlorophyll alb ratio was lower than in high-light (HL) leaves. These indicate that LL leaves invest more N into their light-harvesting systems. However, this N investment did not contribute to the increase in the quantum yield of photosynthesis on the incident photon flux density (PFD) basis (Qi) in LL leaves. N allocation to ribulose 1,5-bisphosphate carboxylasel oxygenase (Rubisco) was significantly higher in HL-high N (HN) leaves than in other leaves. On the other hand, N allocation to C4 enzymes [phosphoenolpyruvate carboxylase (PEPC) and pyruvate Pi dikinase (PPDK)] was unaffected by the growth conditions. Maximum photosynthetic rates (Pmax) per Rubisco content were similar irrespective of the growth light treatments. Carbon isotope ratios (delta13 C) in the leaf dry matter were more negative in LL leaves than in HL leaves (LL = -19.3% per hundred, HL = -16.0% per hundred) and independent of leaf N. Vein density was highest in HL-HN leaves, and leaf thickness was unaffected by the growth light treatments. From these results, we conclude that A. cruentus leaves would not acclimate efficiently to low growth light.

The phenotypic plasticity of Glyceria fluitans growing over the water/land gradient

The amphibious species Glyceria fluitans successfully thrives in an intermittent ecosystem Lake Cerknica, where floods alternate with dry periods. The species grows over the environmental gradient from open water to dry land. The plant's phenotypic plasticity was studied analysing anatomical, morphological, biochemical and physiological characteristics in specimens from different loca­ tions. Floating leaves were thicker, having abundant aerenchyma, lower chloro­ phyll a+b contents and higher chlorophyll alb ratio. The relative amounts of total UV-B and UV-A screening compounds per leaf area were high and similar in all forms that indicated possibly saturated amounts. The measurement of fluorescence parameters revealed no disturbance in energy harvesting since the values of poten­ tial and effective photochemical efficiencies, photochemical and non-photochemi­ cal quenching were similar over the gradient.

Immunostimulation and growth faltering in UK infants.

The purpose of the study was to determine whether chronic immunostimulation could explain growth faltering in disadvantaged children in the UK, as it does in developing countries such as The Gambia. In all, 216 infants, age 10-21 months, were recruited when blood samples were taken for the routine or clinical purposes of a longitudinal study tracking a larger cohort of children. Aliquots of blood were collected on Guthrie cards to determine blood concentrations of albumin (Alb), alpha(1)-antichymotrypsin (ACT), and immunoglobulin G (IgG). Haemoglobin concentrations were determined by routine hospital laboratory analysis. Heights and weights were measured and converted to z-scores; birth weights were used with recruitment weight to calculate a 'thrive index' for each child. Age-corrected plasma IgG concentration was negatively associated with both height- and weight-for-age z-scores (P = 0.042 and 0.038, respectively) but not with the thrive index or body mass index z-scores. Blood haemoglobin levels were positively related to height- and weight-for age z-scores, as well as to the thrive index (P = 0.026, 0.014, and 0.007, respectively). Although significant, these relationships could only account for a small part the observed growth variation. Although the relationships were weak, the results suggest that some of the observed variation in growth of these UK infants may be explained on the basis of persistent immunostimulation or poor iron status. In terms of markers of immunostimulation (Alb, ACT, ACT:Alb ratio, IgG), both absolute levels and relationships with height-for-age are substantially different than those previously observed in cohort studies of infants in The Gambia.