Low Chloride Research Articles

Lower serum chloride concentrations are associated with an increased risk of death in ICU patients with acute kidney injury: an analysis of the MIMIC-IV database.

The association between baseline serum chloride levels and mortality in patients with severe acute kidney injury (AKI) is unknown. Our aim was to investigate the relationship between baseline blood chloride levels and 28-day mortality in patients with AKI admitted to the ICU and to detect possible effect modifiers in this population. AKI patients with severe critical illness were extracted from the MIMIC-IV. During ICU admission, chloride levels were measured for the first time. Our primary outcome was 28-day mortality in patients with AKI after 24 hours in the ICU. Multivariable logistic regression was used to examine the association between three groups of chloride levels and 28-day mortality, and logistic regression with restricted cubic spline was applied to detect the non-linear trendy. A total of 24,166 patients with critically ill AKI were included in this retrospective cohort study. The total 28-day mortality rate in the ICU was 15.9%. Overall, there was a U-shaped relationship between baseline serum chloride levels and 28-day mortality (non-linear P<0.001). Accordingly, patients with low serum chloride (<96 mEq/L) had a significantly increased risk of death compared to patients with normal serum chloride (96-108 meq/L) (adjusted OR=1.94, 95% CI: 1.68-2.24, P<0.001). None of the variables, including age, gender, 24-hour fluid intake, continuous renal replacement therapy, ventilation, Atrial fibrillation, Sequential Organ Failure Assessment score, whether to measure lactate and AKI stage, significantly modified the association between lower chloride levels and 28-day mortality. Low serum chloride levels at baseline were associated with death at 28 days in intensive illnesses with AKI.

A Machine Learning Model to Predict Diuretic Resistance.

Volume overload is a common complication encountered in hospitalized patients, and the mainstay of therapy is diuresis. Unfortunately, the diuretic response in some individuals is inadequate despite a typical dose of loop diuretics, a phenomenon called diuretic resistance. An accurate prediction model that predicts diuretic resistance using predosing variables could inform the right diuretic dose for a prospective patient. Two large, deidentified, publicly available, and independent intensive care unit (ICU) databases from the United States were used-the Medical Information Mart for Intensive Care III (MIMIC) and the Philips eICU databases. Loop diuretic resistance was defined as <1400 ml of urine per 40 mg of diuretic dose in 24 hours. Using 24-hour windows throughout admission, commonly accessible variables were obtained and incorporated into the model. Data imputation was performed using a highly accurate machine learning method. Using XGBoost, several models were created using train and test datasets from the eICU database. These were then combined into an ensemble model optimized for increased specificity and then externally validated on the MIMIC database. The final ensemble model was composed of four separate models, each using 21 commonly available variables. The ensemble model outperformed individual models during validation. Higher serum creatinine, lower systolic blood pressure, lower serum chloride, higher age, and female sex were the most important predictors of diuretic resistance (in that order). The specificity of the model on external validation was 92%, yielding a positive likelihood ratio of 3.46 while maintaining overall discrimination (C-statistic 0.69). A diuretic resistance prediction model was created using machine learning and was externally validated in ICU populations. The model is easy to use, would provide actionable information at the bedside, and would be ready for implementation in existing electronic medical records. This study also provides a framework for the development of future machine learning models.

Anionic H-bonds improve the disorganization of starch in metal chloride hydrate-natural deep eutectic solvents

In this study, several kinds of metal chloride hydrates were added into NADESs (natural deep eutectic solvents) and a series of three constituent-NADESs (3c-NADESs) were successfully developed. The results suggested that the addition of metal chloride hydrates can significantly enhance the solubility of starch, such as, the solubility in MgCl2-CGly-1 is 90.12 ± 3.49 g/100 g, which is 65 times higher than C-Gly (choline chloride-glycerol) (1.38 ± 0.65 g/100 g). The density functional calculation (DFT) suggested that a lower chloride occupancy of 3c-NADESs can provide more chloride ions used for the formation of hydrogen-bonding interaction with starch. Moreover, the molecular dynamic (MD) study demonstrates that Cl− may play a key role as “chisel” during the dissolution of starch, which can efficiently destroy the intra- and intermolecular hydrogen bonds (HO⋯O) of starch, allowed the penetration of other components and prevent the recovery crystal of starch.

Relation of Low Chloride Concentration to Diuretic Efficiency and Transplant-Free Survival in Children Hospitalized With Heart Failure

Serum chloride plays an important role in fluid homeostasis and is associated with impaired diuretic responsiveness and mortality in adults with heart failure (HF). We sought to characterize the relationship of serum chloride and diuretic efficiency (DE) and to determine its prognostic importance in children hospitalized with acute decompensated HF (ADHF). We studied DE, defined as net fluid output/kg+constant per mg of loop diuretic/kg, in 200 children hospitalized with ADHF. Median serum chloride at admission was 102 mmol/L (interquartile range 99 to 105 mmol/L), and hypochloremia (chloride ≤96 mmol/L) was present in 16% of the population at admission. Serum chloride correlated with serum sodium (r=0.66; p < 0.001) and bicarbonate (r=-0.39; p < 0.001). In the adjusted analysis, lower chloride was associated with reduced DE (p < 0.001). Serum sodium was associated with DE on the unadjusted analysis; however, the association was eliminated when added to the model with chloride (p=0.442). Lower chloride was also associated with features of inadequate decongestion during hospitalization: a positive fluid balance (p=0.003), greater cumulative loop diuretic dose per weight (p=0.001), addition of a thiazide diuretic during hospitalization (p < 0.001), less weight loss (p=0.025), and longer length of stay (p=0.003). Chloride concentration was independently associated with death or transplant 1 year after admission (hazard ratio 0.94; p < 0.001). As a dichotomous variable, hypochloremia was independently associated with reduced DE (p < 0.001) and decreased 1-year transplant-free survival (hazard ratio 2.3, p < 0.001). Lower serum chloride at hospital admission is strongly and independently associated with impaired DE and reduced transplant-free survival in children hospitalized with ADHF.

The Investigation of the Impact of Toxicity of Metals on Oxygen-Evolving Complex in Spinacia oleracea.

The current article reported the investigation of metal toxicity on the oxygen-evolving complex (OEC) in Spinacia oleracea related to depletion in chloride ion concentration, an essential part of the photosystem (II). The greenhouse experiment was conducted where S. oleracea was cultivated in three replicates with control plants (plants “a”) treated with tap water. Moreover, 30 ppm of Cu2+ ion solution and Pb2+ ion solution was used to irrigate the rest of the plants, labeled as plants “b” and “c”, respectively, on alternative days. Advanced technologies such as Atomic Absorption Spectrophotometry (AAS), Scanning Electron Microscopy (SEM), Energy Dispersive Spectroscopy (EDS), and UV-visible Spectrophotometry were used to monitor the essential nutrients in leaves to validate the function of the photosystem (I and II). Reduced Cl− ions contents showed that both metals (Cu2+ and Pb2+) altered the essential elements of the oxygen-evolving complex (OEC) of photosystem (II), required to maintain the coordination structure of the Mn4CaO5 cluster. SEM analysis revealed the modified leaf structure of the S. oleracea under Cu2+ and Pb2+ accumulation due to which distorted cellular structure, reduced surface area, and the (shattered) stomatal opening compared to the plants “a” were observed. The EDS analysis of plants “b” and “c” showed high oxygen contents followed by reduced chloride contents over plants “a”, reflecting the infirmity of OEC to push out oxygen, which leads to generating oxidative stress. The lower pigment concentration in leaves of metal-contaminated plants “b” and “c” impacts carbon assimilation, which is linked to the reduced stomatal opening and influences the gaseous exchange rates. Additionally, increased contents of K+ and Ca2+ may be due to self-defense mechanisms under low chloride contents to speed up oxygen evolution to protect plants against oxidative stress. It was concluded that Cu2+ and Pb2+ metal toxicity influences essential Cl− and K+ contents, which modify the photosystem II system; subsequently, a reduced growth rate was observed.

Corrosion evaluation of steel bars in steam-cured concrete under chloride attack and alkali–silica reaction

One of the challenges to reinforced concrete slabs in bridges is deterioration due to rebar corrosion by deicing salts. In order to simulate a concrete slab subjected to deicing salt penetration from the top surface of the bridge slab during winter, high-strength steam-cured concrete with double-layer reinforcements was exposed to 10% sodium chloride solution to investigate rebar corrosion. Five concrete mix proportions were prepared, including high early strength concrete and concrete containing fly ash and blast furnace slag as supplementary cementitious materials (SCMs). For both the high early strength and fly ash concretes, alkali active andesite in the pessimum proportion was mixed with coarse aggregates to investigate the effect of alkali–silica reaction (ASR) on rebar corrosion. It was found that the combined effects of chloride attack and ASR adversely affected the corrosion resistance of high early strength concrete. Fly ash concrete had excellent performance as to corrosion resistance and ASR mitigation. Results also showed that a widely used electrochemical technique known as the half-cell potential test can satisfactorily diagnose corrosion of double-layer reinforced concrete. Concrete specimens containing SCMs with no ASR threat showed no signs of steel bar corrosion and significantly low chloride diffusion coefficients after 3 years.

Efektivitas Koagulan Terhadap Penurunan Energi Potensial Pada Pengolahan Air di PDAM Tirta Pakuan Kota Bogor

In the processing of raw water into clean water need to add coagulant to remove turbidity when the turbidity exceeds the limit specified requirements. Coagulant commonly used for water treatment that Poly Aluminum Chloride (PAC), Aluminum Sulfate and Ferry Chloride. This study aims to determine the optimum dose of coagulant Poly Aluminum Chloride (PAC), Aluminum Sulfate and Ferry Chloride and to compare its effectiveness in water treatment Cisadane in PDAM Tirta Pakun Bogor with different turbidity levels.Cisadane river water sample taken on different days with different turbidity levels. Determination of the optimum dose of coagulant is done by providing different dosage variations. Test parameter and characteristics of raw ait water jar test result of the test, to test the turbidity mearused by the turbidymeter total dissolved solids mearused by conductometer, pH mearused by pH meter, Fe and Mn measured by spectrophotometer and organic substance using titration method. Then the experimental data obtained were compared with the reqquirements of Permenkes No. 492/Menkes/iv/2010.Of the result obtained optimum dose at low turbidity coagulant Poly Aluminum Chloride (PAC) 30,2 NTU at 14 mg/L and Ferry Chloride at 16 mg/L.. While high turbidity of 681 NTU, the optimum dose for coagulant Poly Aluminum Chloride (PAC) at 35 mg/L, Aluminum Sulfate at 5 mg/L and Ferry Chloride at 40 mg/L. Coagulant more effective water treatment raw cisadane river in the PDAM Tirta Pakuan Bogor is coagulant Poly Aluminum Chloride(PAC). Because Poli Aluminium chloride is more effective in reducing potential energy as a barrier energy in the aggregation process.

Assessing the critical chloride threshold of conventional reinforcement embedded in alternate cementitious systems

Alternate cementitious materials (ACMs), such as calcium aluminate cements (CAC) and calcium sulfoaluminate cements (CSA), contain lower embodied energy and carbon footprints when compared to traditional ordinary portland cement (OPC) systems. However, the sustainability of these ACM systems can be nullified by a lack of durability and/or resiliency. To develop an understanding of the durability and long-term performance of the ACMs, standardized test methods are required to assess their corrosion resistance. OCcrit, a new test method that was developed at Oregon State University, is a fast and reliable method to study the corrosion performance of cementitious systems. This method, however, has only been evaluated using OPC systems. In the first part of this study, testing was performed to potentially extend the applicability of this new test method to CAC and CSA systems, thereby increasing its robustness and value. In the second part of the study, the updated OCcrit method was used to assess the critical chloride threshold of steel reinforcement embedded in CAC and CSA systems. Results indicate that CSA specimens exhibit lower critical chloride threshold values than OPC and CAC specimens and the critical chloride threshold of the CAC seems to be dependent on the water-cementitious materials ratio.

Aqueous Speciation of Tetravalent Actinides in the Presence of Chloride and Nitrate Ligands.

Speciation of hexachloride tetravalent uranium, neptunium, and plutonium species in aqueous media has been investigated using density functional theory in the presence of inner sphere ligands such as chloride, nitrate, and solvent molecules. All possible structures with the formula [AnIV(Cl)x(H2O)y(NO3)z]4-x-z (An = U, Np, and Pu; x = 0-6, y = 0-8, and z = 0-6) were considered to explore the speciation chemical space of each actinide. The nature of the mixed-ligand complexes present in solution is controlled by the concentration of free ligands in solution. A low chloride concentration is suitable to drive the speciation away from the highly thermodynamically stable hexachloride species. Furthermore, the formation of dimeric species can proceed through both olation and oxolation mechanisms. Oxolation is preferred for monomers that contain fewer water ligands, while olation becomes favorable for complexes with more water ligands.

Intermittent Hypoxia Interferes with Autocrine Effects of GABA on Insulin Secretion in Postnatal Rodents-Implications for Pediatric Obstructive Sleep Apnea.

Gamma-amino butyric acid (GABA) is well known to help elevate pancreatic β cell vitality and insulin levels in blood. GABA works via a coupling with GABA receptors; thus, the concentration of GABAA receptors on the plasma membrane of β cells appears to be critical for insulin regulation. Various medical conditions, such as pediatric and adult obstructive sleep apnea (OSA), show high levels of Type 2 diabetes; such patients also are exposed to intermittent hypoxia (IH), which modifies the GABA levels. To evaluate the potential therapeutic roles of GABA for diabetic patients with OSA, we studied the interactions of IH with GABA and GABAA receptors in young rats. Using rat pups and primary pancreatic islets, we evaluated the roles of GABA in insulin secretion. We show that GABA effectively increased the insulin secretion of pancreatic islets under normal ambient oxygen levels, as well as in culture medium with a glucose level of 2 mM. GABA also increased islet insulin secretion conditioned under IH in a 16 mM glucose medium. When islets were IH-treated, insulin secretion decreased due to lower intracellular chloride levels in accordance with the increased KCC2 levels. The results show that IH challenges down-regulate the GABAA receptor levels in pancreatic islets, which decreases GABA–GABAA receptor coupling action, as well as membrane depolarization for insulin secretion. The findings have the potential to suggest novel interventions for insulin regulation during IH of disordered breathing, including OSA.

Effect of limestone powder addition on corrosion initiation time of reinforced concrete

This work aimed to evaluate the effects of limestone powder (LP) replacement fraction (8–24 wt%) on chloride diffusion and chloride threshold (Cth) for corrosion initiation. Depassivation of steel was diagnosed by monitoring the self-corrosion potential and corrosion current density using open circuit potential and AC impedance tests, respectively. Corrosion initiation time (Tini) was estimated based on the measured Cth coupled with a dual time-varying diffusion model. The results indicate that the chloride diffusion coefficient decreases with 8 wt% LP addition, though further increase in LP content reverses the trend. With increasing exposure duration, both the surface chloride concentration and diffusion coefficient vary remarkably at first and eventually tend to be stable. As the cover depth decreases from 55 mm to 45 mm, Tini is found to decrease by 30.0%–42.9%. Incorporation of LP appreciably decreases Cth regardless of its replacement fraction, consequently leading to a decreased Tini, despite a low chloride diffusivity can be obtained with appropriate LP addition.

Abstract P2097: Hypochloremia Alters Cardiac Physiology After Myocardial Ischemia-Reperfusion Injury

Ischemic heart disease (IHD) is one of the leading causes of death related due to heart failure (HF). It is mainly characterized by impairment of heart contraction-relaxation (rhythmicity) and cardiac output. While a myriad of cellular processes is associated with IHD, one of the major cellular aspects strongly associated is the electrolyte and ionic imbalance. Serum sodium levels have been a well-established adverse prognostic marker for patients with chronic heart failure. Recent evidences have suggested that the lower serum chloride (hypochloremia, &amp;lt90mM) is associated with increased mortality risk in patients with chronic HF independent of serum sodium levels. Serum chloride (Cl - ) is a major anion in physiology but its correlation to IHD has not been studied extensively. Hence, to better understand the role of hypochloremia in HF patients, we reviewed patients who received a left ventricular assist device (LVAD) placement at The Ohio State University Medical Center. Survival analysis demonstrated that patients with hypochloremia before LVAD placement had decreased survival at one year compared to patients with normal serum Cl - (p=0.0055). Moreover, our e x vivo studies with isolated rat hearts indicate hypochloremia aggravates myocardial infarction post ischemia-reperfusion (IR) injury. Hence, to elucidate Cl - mediated signaling mechanism we incorporated highly translational human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CM). Our cellular studies demonstrate that physiological alteration of extracellular Cl - affects the function of beating hiPSC-CM. Hypochloremia significantly increases the beating rate by reducing the calcium cycling durations in hiPSC-CM. Studies are ongoing to determine the involvement of the chloride channel in maintaining chloride homeostasis. Taken together, our results for the first time establish the novel role and mechanism of chloride homeostasis in IR injury. These results will advance the need to search for effective therapeutic approaches to target novel Cl - channels in IHD.

Disease severity of people with cystic fibrosis carrying residual function mutations: Data from the ECFS Patient Registry

RationalPeople with cystic fibrosis carrying residual function (RF) mutations are considered to have a mild disease course. This may influence caregivers and patients on how intensive the treatments should be. ObjectivesCharacterize disease severity of patients carrying RF mutations, using the European CF Society Patient Registry (ECFSPR) data. MethodsDemographic, clinical characteristics, lung function and death probability of patients carrying at least one RF mutation were analyzed and compared to patients homozygous to minimal function mutations (MF). Main resultsOf the 44,594 eligible patients (median age 19.5 years, IQR 10–29.8), 6,636 (14.6%) carried RF mutations, and 37,958 (85.1%) MF mutations. Patients carrying RF mutations were older, diagnosed at a later age, had lower sweat chloride at diagnosis and better FEV1pp at each age group. However, their FEV1pp declined with age and rates of chronic Pseudomonas aeruginosa increased with age. A significant number of patients with RF had FEV1pp similar to patients with MF at each age group. 4.5% of RF patients were treated with oxygen and 2.61% had a lung transplant. With increasing age, 26.6% of RF patients were treated with pancreatic enzymes associated with a more severe lung disease. RF patients had shortened life spans, with mortality starting around the age of 20 years. ConclusionsPatients carrying an RF mutations experience a decline of pulmonary function with age, leading to life-shortening. Standard of care therapies and augmenting CFTR function may improve their survival and quality of life.

Physicochemical Analysis of Potable Water in Baham Community, Western Region of Cameroon

Safe and easily accessible water is important for community health. This paper presents the physicochemical analysis of water in Baham community, western region of Cameroon by collecting water samples from boreholes, well and stream. Physiochemical analysis using gravimetric and titrimetric methods were carried out on the collected samples and they were analysed based on their temperature, pH, colour, odour, total dissolved solid (TDS) and total suspended solid (TSS), sulphate, lead and chloride concentration as well as acidity and alkalinity. The results showed low pH values between 5.39 and 6.11 for all samples, an average temperature of 20°C, agreeable colour and odour for all samples but for the stream, which had colour, odour, very low TDS between 10-20 mg/l, TSS between 10 and 50 mg/l, acceptable for all but the stream and well samples which had a concentration of 30mg/l and 50mg/l respectively, very low chloride concentration level of 8-23 mg/l compared to WHO’s recommended 250 mg/l, very high sulphate contents of 246.9-493.8 mg/l and lead concentrations of 0.27-0.30 mg/l which is about 5 times the recommended 0.05 mg/l WHO permissible limit. The results showed high acidity (60-110 mg/l) and alkalinity (50-150 mg/l) values which fall within acceptable limits. From the results above, it was concluded that the quality of water in Baham is not fit for consumption according to WHO standards. It is acidic, lacks essential minerals, not properly disinfected and has disturbingly high lead concentrations.

Physicochemical and Microstructural Analyses of Pepsin-Soluble Collagens Derived from Lizardfish (Saurida tumbil Bloch, 1795) Skin, Bone and Scales.

Reducing food waste is critical for sustainability. In the case of fish processing, more than sixty percent of by-products are generated as waste. Lizardfish (Saurida tumbil Bloch, 1795) is an economically important species for surimi production. To address waste disposal and maximize income, an effective utilization of fish by-products is essential. This study aims to isolate and characterize pepsin-soluble collagens from the skin, bone and scales of lizardfish. Significant differences (p < 0.05) in the yields of collagen were noted with the highest yield recorded in pepsin-soluble skin collagen (PSSC) (3.50 ± 0.11%), followed by pepsin-soluble bone collagen (PSBC) (3.26 ± 0.10%) and pepsin-soluble scales collagen (PSCC) (0.60 ± 0.65%). Through SDS–polyacrylamide gel electrophoresis, the presence of two alpha chains were noted and classified as type I. From Fourier transform infrared spectroscopy (FTIR) analysis, the triple-helix structure of the collagen was maintained. The X-ray diffraction and UV visible spectra characteristics of the lizardfish collagens in this study are similar to the previously reported fish collagens. In terms of thermostability, PSSC (Tmax = 43.89 °C) had higher thermostability in comparison to PSBC (Tmax = 31.75 °C) and PSCC (Tmax = 30.54 °C). All pepsin-soluble collagens were highly soluble (>70%) in acidic conditions (particularly at pH 4.0) and at low sodium chloride concentrations (0–30 g/L). Microstructural analysis depicted that all extracted collagens were multi-layered, irregular, dense, sheet-like films linked by random coiled filaments. Overall, pepsin-soluble collagens from lizardfish skin, bone and scales could serve as potential alternative sources of collagens.

Light Spectrum Effects on the Ions, and Primary and Secondary Metabolites of Red Beets (Beta vulgaris L.)

Red beet (Beta vulgaris L.) is a root vegetable consumed and cultivated all around the world. It contains plenty of sugars, inorganic ions and a variety of secondary metabolites known to improve human health. The aim of this work was to investigate the effect of light spectra on red beets and their components in a vertical farm (VF) compared to open field (OF). RED (red:blue-white = 4:1)-treated shoots elevated total phenolic contents (TPC) among lights. Sugar content in VF red beets was 4.2 times higher than beets from OF. Betalains in VF red beets were 2.4–2.8 times higher than OF ones, and RED-treated roots had significantly higher betalain levels compared to CON (red:blue-white = 2:1)-treated ones. VF red beets contained a higher level of inorganic nitrates and lower chloride compared to OF beets. In conclusion, the light spectrum alters the concentration of beet components to be higher than that of OF red beets, and RED light elevated TPC, sugars and betalains.

Sweet basil can be grown hydroponically at low phosphorus and high sodium chloride concentration: Effect on plant and nutrient solution management

Agronomic inputs in agriculture easily exceed crop needs causing environment pollution. Phosphorus (P) is a macronutrient largely used in agriculture as a mineral fertilizer that requires an accurate management because it is a finite and non-renewable resource. Growing plants hydroponically can optimize plant nutrition achieving high crop nutrient use efficiency. However, irrigation water of poor quality (saline) interferes with crop performance. In this study, the effects of different P and NaCl levels in the root zone were evaluated on basil plants grown in a deep liquid culture system in a growth chamber. Two experiments with different P (from 0.1 to 1.0 mol m−3) and NaCl (from 0 to 60 mol m−3) concentrations in the nutrient solution were carried out. Plant growth, leaf gas exchanges and fluorescence, uptake of minerals and water, and leaf quality (content of minerals and pigments, and antioxidant capacity) were analysed. The most relevant morphological plant response to the low P (i.e., roughly 0.1 x of a standard nutrient solution) concentration consisted in a greater root/shoot ratio. However, plants growing at low P concentration did not show any reduction in yield and quality. Sodium chloride did not significantly affect plants yield and quality up to a concentration of 30 mol m−3 confirming the tolerance of basil to moderate saline stress. Significant reduction in the total biomass, water uptake and photosynthesis instead occurred at NaCl 60 mol m−3. These results confirmed the hypotheses that basil can be grown hydroponically at low P and high NaCl concentration with proper management of the nutrient solution. The absence of significant interactions between P and NaCl suggests that these two factors can be managed independently with potential benefits for crop economic and environmental sustainability.

Localized Corrosion of Chromium-Containing Conventional and Multiprincipal Element Alloys in Methanol and Aqueous Chloride Environments

The localized corrosion behavior of Type 304L stainless steel (UNS S30400), Alloy 625 (UNS N06625), and three experimental NiCoCrMo multiprincipal element alloys (MPEA), exposed to methanol/lithium chloride solutions with different water contents, is examined in this paper. Cyclic potentiodynamic polarization tests indicated that water increased the pitting and repassivation potentials and the critical temperature at which localized corrosion occurred in chloride solutions. The effect of water on repassivation potential in methanol-chloride solution depended on the chloride concentration and alloy content. At lower chloride concentration and higher alloy content, water had a greater inhibiting effect on repassivation potential, suggesting a competitive reaction between chloride and water on the metal surface in the pit. The localized corrosion resistance of the MPEAs followed the same trend as that of commercial stainless steels and Ni-base alloys in terms of the effect of alloying elements. The implications of these results on the mechanisms of localized corrosion are discussed.

무기질 혼화재를 사용한 해양콘크리트의 현장 적용성 검토

In this study, the effects of the kind and replacements of mineral admixtures on the properties of offshore concrete were investigated. The results showed that the compressive strength of concrete made with fly ash (FA) was 16.1~24.1% higher than that of concrete made with FA and silica fume (SF). The concrete made with ground granulated blast-furnace slag (GGBS) showed the lowest chloride ion diffusion coefficient. However, GGBS concrete showed a higher length change than ordinary portland cement (OPC) concrete. Furthermore, the low productivity of high durable offshore concrete should be considered because it has a low apparent yield value and high plastic viscosity.

Tolerability of Sacubitril/Valsartan in Patients With Advanced Heart Failure: Analysis of the LIFE Trial Run-In

BackgroundThe LIFE (LCZ696 In Hospitalized Advanced Heart FailurE) trial, which evaluated sacubitril/valsartan in patients with advanced heart failure (HF) with reduced ejection fraction and recent New York Heart Association functional class IV symptomatology, did not require tolerance to a renin angiotensin system antagonist before initiating sacubitril/valsartan, thus affording an opportunity to study the tolerability of sacubitril/valsartan in advanced HF with reduced ejection fraction. ObjectivesThe goal of this analysis of the LIFE trial is to characterize the tolerability of initiating sacubitril/valsartan in patients with chronic advanced HF with reduced ejection fraction. MethodsIn the LIFE trial, 445 subjects with advanced HF entered an unblinded run-in period of 3-7 days with sacubitril/valsartan 24/26 mg twice a day. The authors compared characteristics of subjects completing and failing run-in, performed multivariable analysis of clinical parameters associated with run-in failure, and developed a predictive model for short-term intolerance to sacubitril/valsartan. ResultsOf 445 subjects entering run-in, 73 (18%) were intolerant of sacubitril/valsartan. Reasons for intolerance included systolic blood pressure <90 mm Hg (59%), symptoms of hypotension/dizziness with systolic blood pressure >90 mm Hg (19%), and renal dysfunction (creatinine >2.0 mg/dL) (12%). Multivariable predictors of intolerance included lower mean arterial pressure, lower serum chloride, presence of an implantable cardioverter-defibrillator and/or cardiac resynchronization device, moderate or greater mitral regurgitation, nonuse of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at the screening visit, and use of insulin at screening. Subjects with 4 or more predictors had a 48.9% probability of sacubitril/valsartan intolerance. ConclusionsIntolerance to low doses of sacubitril/valsartan is common in patients with advanced chronic HF with reduced ejection fraction and may be predicted by the presence of certain risk factors. (EntrestoTM [LCZ696] in Advanced Heart Failure [LIFE Study] [HFN-LIFE] NCT02816736)