Serum Albumin Levels Research Articles

Preoperative low serum albumin increases the rate of perioperative blood transfusion in patients undergoing total joint arthroplasty: propensity score matching

BackgroundTo investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA).MethodsWe enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes.ResultsAn under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888–0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50–2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30–37.3 g/L, 25–30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37–1.99, P < 0.001), 5.4 (95% CI 3.08–9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively.ConclusionIn TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion.Trial registration28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.

The prevalence and risk factors associated with zinc deficiency after pancreatic surgery.

To clarify the prevalence, risk factors, and clinical implications associated with zinc deficiency in patients undergoing pancreatic surgery. The serum zinc levels were measured in 329 patients post-pancreatic surgery between January and April 2021. The postoperative serum zinc levels and clinicopathological variables were retrospectively analyzed. The median serum zinc level was 73µg/dL (33-218). Zinc deficiency (zinc level < 60µg/dL) was observed in 52 patients (16%). A total of 329 patients were classified into zinc-deficient (n = 52) and non-deficient (zinc ≥ 60µg/dL, n = 277) groups. A univariate analysis revealed significant differences in sex, postoperative body mass index, serum albumin, total cholesterol, creatinine, aspartate aminotransferase (AST), HbA1c levels, diabetes, surgical procedures, and operative blood loss. According to a multivariate analysis, male sex [odds ratio (OR) 3.70; 95% confidence interval (CI) 1.67-8.20; p = 0.001], postoperative serum albumin levels < 3.9g/dL (OR 6.39; 95% CI 3.30-12.37; p < 0.001), postoperative serum AST ≥ 51 U/L (OR, 4.6; 95% CI 0.07-0.29; p < 0.001), and total pancreatectomy (OR 3.68; 95% CI 1.37-9.85; p = 0.009) were found to be independent predictors of zinc deficiency after pancreatic surgery. Zinc deficiency frequently occurs in patients undergoing pancreatic surgery. Lower postoperative zinc levels could be linked to sex, the serum albumin and AST levels, and surgery type.

SARS-CoV-2 spike aggravates lupus nephritis and lung fibrosis in systemic lupus erythematosus

ObjectiveCOVID-19 induces the development of autoimmune diseases, including SLE, which are characterised by inflammation, autoantibodies and thrombosis. However, the effects of COVID-19 on SLE remain unclear.MethodsWe investigated the effects of...

Assessing the Utility of the Metabolic Score for Insulin Resistance (METS-IR) in Evaluating Metabolic Risk Among Individuals Undergoing Master Health Checkups in a Tertiary Care Hospital in South India: A Retrospective Cohort Study.

Background The metabolic score for insulin resistance (METS-IR) is a neoteric score for assessing insulin resistance that has been used as a non-insulin-based, objectively measured method. It is an easily accessible tool that can be used on a large scale to detect insulin resistance in a community. Methods We conducted a retrospective cohort study to explore the utility of this score in identifying metabolic risk in those individuals attending a master health checkup in a tertiary care setting. Data were collected from 254 individuals between October and December 2023. Results According to the univariate regression analysis, METS-IR had a strong correlation in predicting cardiovascular health risks, as evidenced by its positive linear association with an increase in age (β=0.186, p=0.003), weight (β=0.534, p<0.001), waist circumference (β=0.405, p<0.001), and body mass index (BMI; β=0.635, p<0.001). This explained the value of this score in depicting adiposity and insulin resistance. Lab parameters that showed a significant association were fasting blood sugar (β=0.176, p=0.005) and fasting triglycerides (β=0.175, p=0.005). According to the multivariate regression analysis, METS-IR had a significant positive association with fasting blood sugar (B=0.489, p<0.001) and fasting triglycerides (B=0.022, p=0.003), implicating its importance in cardiovascular health. High-density lipoprotein cholesterol (HDL-c; B=-0.168, p=0.005) confirmed its protective role with its negative association in higher quartile groups. An increase in serum albumin levels (B=-0.168, p=0.005) and raised gamma-glutamyl transpeptidase (GGT) (B=0.059, p=0.022) portrays its due diligence in liver health. METS-IR had a weak association with the estimated glomerular filtration rate (eGFR) with Pearson's correlation coefficient of 0.020 (p=0.756) and Spearman's rho of 0.021 (p=0.739). However, raised serum creatinine had a significant association in higher quartile groups, with a p-value of 0.018. Conclusions METS-IR is useful as a screening tool for predicting cardiovascular disease. However, the complex interplay of other confounding factors in identifying renal dysfunction has yet to be explored when considering this score in our study population.

Serum zinc level in liver cirrhosis with hepatic encephalopathy and its correlation with different stages of hepatic encephalopathy.

Hepatic encephalopathy (HE) severe complication of liver cirrhosis with high mortality. Few studies have found zinc deficiency in liver cirrhosis and HE patients and found it as a precipitating factor for the development of HE. This study was done to measure the serum zinc level in patients with liver cirrhosis with HE and a correlation was obtained between serum zinc level with grades of HE. A cross-sectional observational study was done on 150 patients with liver cirrhosis with HE at a tertiary care center in Jharkhand. All cases were evaluated by history taking, clinical examination, and a questionnaire and classified into different WHC grades of HE and CPC classes of cirrhosis. Routine blood investigations, imaging studies, and morning serum zinc levels were done for all patients. Majority of patients with liver cirrhosis with HE had zinc deficiency. There was a statistically highly significant (P < .00001) association between low serum zinc levels and WHC grades of HE. The serum zinc levels in different classes of cirrhosis showed highly significant differences (P < .00001). The mean serum zinc level was significantly low in patients who died (35.56 ± 11.65 vs 48.36 ± 10.91, P < .0001). The study revealed a strong positive correlation (r = .88, P = .048) between serum zinc and serum albumin levels. Serum zinc is deficient in patients with liver cirrhosis and HE. Zinc deficiency is significantly associated with higher severity of cirrhosis and higher grades of HE. All patients with liver cirrhosis with HE and hypoalbuminemia should be evaluated for zinc deficiency.

Underweight, dementia, and not being completely independent in bowel management are risk factors for urinary incontinence among older people

Background:Despite the known relationship between frailty and urinary incontinence, the components of frailty that are important in managing urinary incontinence remain unclear. Objectives:This study aimed to investigate physical factors that influenced urinary incontinence. Methods:This prospective observational study included patients admitted to the rehabilitation ward of our hospital from July 2020 to June 2022. Patients’ data were collected during the week before their discharge. Patients who needed diaper changes because of urine contamination were defined as incontinent and others as continent. Univariate and multivariate analyses were used to analyze differences between the two groups by age, sex, medical history, body mass index, serum albumin levels, Mini-Mental State Examination scores, Functional Independence Measure motor items (excluding bladder management), grip strength, gait speed, lower limb muscle strength, posture when seated on the toilet, residual urine volume, medication for lower urinary tract symptoms, and polypharmacy. Results:Of 121 patients, 104 (38 men, 66 women) were included in our analyses. Patients’ median age was 81 years (range 56–101 years). The risk factors for urinary incontinence identified in the multivariate analysis were: history of dementia (odds ratio [OR] 19.80, 95% confidence interval [CI]: 2.31–170.00; p = 0.00646), body mass index < 18.5 kg/m2 (OR 7.09, 95% CI: 1.36–36.90; p = 0.0201), and non-completely independent bowel management (OR 7.19, 95% CI: 1.29–40.16; p = 0.0245). Conclusions:We concluded that dementia, low body mass index, and non-completely independent bowel management are associated with urinary incontinence among older people.

Pilot Trial of Hydroxychloroquine as Add-On Therapy in Patients With Membranous Nephropathy

BackgroundKidney Disease Improving Global Outcomes guidelines indicate that glucocorticoids and immunosuppressants comprise the first therapeutic regimens after 4–6 months of treatment for high-risk primary membranous nephropathy (PMN). However, some patients cannot achieve complete or partial remission at 6 months. This study aimed to evaluate the efficacy of traditional immunotherapy combined with hydroxychloroquine (HCQ), a well-known immune regulator, in patients with PMN. MethodsThis was a single-center, open-label, prospective study. We recruited 72 patients with nephrotic syndrome and PMN proven by renal biopsy from May 2020 to June 2024. We compared changes in proteinuria, serum albumin levels, estimated glomerular filtration rate, and relapse rate at 3, 6, 9, and 12 months follow up in 41 patients who received glucocorticoid and immunosuppressant, and in 31 who received HCQ plus standard-of-care. ResultsBaseline characteristics showed no statistical significance between the two groups. However, the HCQ group showed significantly reduced proteinuria compared to standard-of-care group. A reduced proteinuria was seen at 6 months [1.2 (0.4, 2.2) vs. 2.2 (1.0, 3.8) g/day, P = 0.029] and the relapse rate with 12 months follow up was also significantly decreased in HCQ group compared to standard-of-care group (3.7% vs. 23.3%, P = 0.033). ConclusionsHCQ may serve as an effective add-on therapy for primary membranous nephropathy.

Hypoalbuminemia on admission in diabetic patients correlates with severity of illness in COVID-19: A retrospective clinical study and literature review

IntroductionTo elucidate factors associated with severe disease in patients with coronavirus disease 2019 (COVID-19) pneumonia complicated with diabetes mellitus. MethodsAmong patients with COVID-19 pneumonia hospitalized from January to September 2021, 100 patients with diabetes were included in the study. Patients in the intensive care unit admission or in-hospital death category were defined as the severe group (26 patients), and the other patients as the moderate group (74 patients). Comparisons were made between the two groups. Medical histories were extracted from the medical records, and statistical analysis was performed. ResultsPatients were 62.1 ± 13.0 years of age, 70 % male, 48 % aged 65 years and more, and HbA1c was 7.72 ± 1.51 %. The severe group had significantly higher blood glucose level, CRP, WBC, and LDH on admission. Serum albumin level was significantly lower in the severe group and was significantly negatively correlated with number of days on oxygen administration (r = 0.447) and maximal oxygen concentration (r = 0.561). Multiple logistic regression analysis with severity of illness as the objective variable showed that high CRP and low albumin levels on admission, and older age were independently associated. ConclusionsLow albumin levels on admission may be an indicator of severe disease in patients with diabetes.

The protective effect of hydroalcoholic Citrus aurantifolia peel extract against doxorubicin-induced nephrotoxicity

Background and purpose: Doxorubicin chemotherapy is a widely used treatment for various cancers, including breast, ovarian, and uterine cancers, among others. However, long-term use can cause nephrotoxicity side effects. Some citrus flavonoids have demonstrated nephroprotective activity; therefore, this study aimed to test the nephroprotective effectiveness of Citrus aurantifolia peel extract in protecting and reducing kidney damage caused by doxorubicin. Experimental approach: Citrus aurantifolia peel was dried, ground, and extracted by ultrasonication (70% ethanol), then the extract was dried. Twenty-five female Sprague-Dawley rats were divided into 5 groups including the normal group (control), positive control (doxorubicin) group receiving doxorubicin at the repeated intraperitoneal (i.p.) dose of 4 mg/kg/day on days 2, 6, 10, and 14, and treatment groups receiving Citrus aurantifolia peel extract (CPE) with the doses of 100, 200, and 400 mg/kg/day orally for 14 days, and doxorubicin (4 mg/kg/day, i.p.) on days 2, 6, 10 and 14. On day 15, the rats were euthanized for the measurements of MDA, superoxide dismutase (SOD), catalase, kidney function (measuring blood urea nitrogen (BUN), creatinine, albumin serum levels), and renal histopathology. Findings/Results: The CPE yield was 16.13%. CPE could significantly reduce the levels of MDA, and increase SOD and catalase activities compared with the doxorubicin-induced nephrotoxic model. CPE could increase renal function by reducing BUN and creatinine levels, increasing albumin, and improving the histopathology of the kidney. Conclusion and implications: CPE has a potential effect as nephroprotective against doxorubicin-induced toxicity in renal through antioxidant capacities and increased renal function.

322. IMPACT OF POSTOPERATIVE NUTRITIONAL SUPPORT MODES ON CLINICAL AND PATIENT-REPORTED OUTCOMES IN ENHANCED RECOVERY AFTER ESOPHAGECTOMY FOR CANCER

Abstract Background Enhanced Recovery After Surgery (ERAS) for esophagectomy has been demonstrated to be safe and effective. However, there is significant variation in the nutritional support treatment modes during the perioperative period. We have recently developed a novel ERAS nutritional support mode. In this study, we compared this new mode with the previous ERAS nutritional support treatment mode to assess their impact on clinical and Patient-Reported Outcomes (PROs), aiming to develop an optimal approach. Methods We enrolled 357 patients who underwent esophagectomy for esophageal thoracic cancer or esophagogastric junction cancer from June 2021 to August 2023. Two different ERAS nutritional support treatment protocols were used postoperatively: the control group previously received enteral nutrition by nasojejunal tube + parenteral nutrition + early oral diet after surgery, while the study group currently received parenteral nutrition + early oral diet. We compared the two groups in terms of clinical observation indicators, hematological analysis, serum protein changes and clinical outcomes. The comparison of quality of life on PROs was assessed using the MD Anderson Symptom Inventory. Symptom changes were analyzed using a mixed-effects model. Results A total of 324 patients successfully completed the ERAS nutritional support protocols. The success rates were 91% in the control group and 90.2% in the study group, with no statistically significant difference (p&amp;gt;0.05). The incidence of complications did not significantly differ between the two groups (p&amp;gt;0.05). Compared to the control group (n=223), the study group (n=101) significantly shortened the chest drain time (6.2±2.6 days vs. 6.6±1.5 days, p&amp;lt;0.05) and elevated the levels of serum total protein and albumin on the 4th postoperative day (53±5 g/L vs. 51±4 g/L, 30±2 g/L vs. 28±2 g/L, p&amp;lt;0.05). There were no statistically significant differences in the first flatus time, first defecation time, infusion time and postoperative hospital stay between the two groups (p&amp;gt;0.05). The comparison of hematological analysis, serum protein changes, changes in body weight during the perioperative period and 30-day readmission rate showed no statistically significant differences (p&amp;gt;0.05). In the MD Anderson Symptom Inventory, the study group had significantly better scores in sadness, dry mouth, enjoyment of life, and general activity dimensions compared to the control group (p=0.013, p&amp;lt;0.001, p=0.045, p=0.008). Conclusion Based on the similar rehabilitation outcomes, the simplified ERAS nutritional support treatment mode without postoperative enteral nutrition by nasojejunal tube is more optimized because it is physiological sound and significantly improves quality of life on PROs.

The relationship between Glasgow Prognostic Score and hospital duration in patients with inflammatory bowel diseases.

Both hypoalbuminemia and inflammation were common in patients with inflammatory bowel diseases (IBD), however, the combination of the two parameters on hospital duration re-mained unknown. This is a retrospective two-centre study performed in two tertiary hospitals in Shanghai, China. Serum levels of C-Reactive Protein (CRP) and albumin (ALB) were measured within 2 days of admission. Glasgow prognostic score (GPS), based on CRP and ALB, was calculated as follows: point "0" as CRP <10 mg/L and ALB ≥35 g/L; point "1" as either CRP ≥10 mg/L or ALB <35 g/L; point "2" as CRP ≥10 mg/L and ALB <35 g/L. Patients with point "0" were classified as low-risk while point "2" as high-risk. Length of hospital stay (LOS) was defined as the interval between admission and discharge. The proportion of low-risk and high-risk was 69.3% and 10.5% respectively among 3,009 patients (65% men). GPS was associated with LOS [β=6.2 d; 95% CI (confidence interval): 4.0 d, 8.4 d] after adjustment of potential co-variates. Each point of GPS was associated with 2.9 days (95% CI: 1.9 d, 3.9 d; ptrend<0.001) longer in fully adjusted model. The association was stronger in patients with low prealbumin levels, hypocalcaemia, and hypokalaemia relative to their counterparts. GPS was associated with LOS in IBD patients. Our results highlighted that GPS could serve as a convenient prognostic tool associated with nutritional status and clinical outcome.

Clinical Characteristics of Patients with Nontuberculous Mycobacterium Pulmonary Disease in Fuyang, China: A Retrospective Study.

We retrospectively review consecutive patients with nontuberculous mycobacterium (NTM) pulmonary disease reported from a designated hospital for infectious diseases in the Fuyang district of China to determine the clinical characteristics of these patients. This research enrolled 234 patients with NTM pulmonary disease between January 2018 and May 2023 in the Fuyang district of China. Data were collected from the electronic medical records. The NTM strain composition and clinical characteristics of NTM pulmonary disease were retrospectively analyzed. 73 (31.20%) patients had previous tuberculosis (TB) or TB exposure history and bronchiectasis. Mixed NTM infection accounted for 12.39%. Mycobacterium intracellulare strain was detected in 132 patients (49.62%). Women were found to be more affected by Mycobacterium avium infection, and men by Mycobacterium abscessus infection. Mycobacterium avium (34.21%) and Mycobacterium abscessus (33.33%) strains were most common in people with previous TB or TB exposure history. Among respiratory tract-related diseases, patients with bronchiectasis had the highest isolation rate of Mycobacterium avium (55.36%). Women were susceptible to bronchiectasis (P <0.01). The median of mononuclear-to-lymphocyte ratio (MLR) was higher in men than in women (P < 0.01). The serum albumin (ALB) level was lower in patients with TB or TB exposure history than in those without TB history (P = 0.034). The prognostic nutritional index (PNI) was lower in patients with TB or TB exposure history than in those without tuberculosis history (P = 0.021). Patients with NTM lung disease were poorly treated. Clinical symptoms of the disease were not species-specific. Mycobacterium intracellulare and Mycobacterium avium strains were predominant in the Fuyang district of China. Previous TB or TB exposure history immensely enhanced the risk of NTM disease.

Prevalence of hyponatremia among medically hospitalized patients and associated outcomes: a retrospective cohort study.

Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes. Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia. Retrospective cohort. Medical ward at tertiary hospital setting. The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge). The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin. The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality. In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (P<.01), predominantly female (P=.014), and had lower serum magnesium and albumin levels (P<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (P<.01, P<.01, P=.045, P<.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (P<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, P<.01 [95% CI; 0.69-0.94]). Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission. Single-centre design and retrospective nature.

Impact of ultra-early enteral nutrition support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage

To investigate the effect of ultra-early enteral nutrition (UEEN) support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage. The clinical data of young and middle-aged patients (aged 18-59 years) admitted to Tianjin Fifth Central Hospital from January 2020 to June 2023 after surgery for intracerebral hemorrhage were retrospectively analyzed, and the general data, nutritional indexes, gastrointestinal complications, neurological function recovery and long-term prognosis of the patients were recorded. According to the time of initiation of enteral nutrition (EN) support, patients were divided into UEEN group (EN implementation within 12 hour after surgery) and early enteral nutrition (EEN) group (EN implementation within 24 to 48 hour after surgery). The differences of the above indexes between the two groups were analyzed and compared. A total of 64 young and middle-aged postoperative patients with cerebral hemorrhage were enrolled, including 32 cases in the UEEN group and 32 cases in the EEN group. There were no significant differences in gender, age, proportion of hypertension and diabetes, Glasgow coma score (GCS) on admission and surgical methods between the two groups. In terms of nutritional indexes, serum total protein, albumin and hemoglobin levels of patients in both groups on day 7 after admission were lower than those on day 1, and higher than those on day 3, and the above indexes levels in UEEN group were significantly higher than those in EEN group on day 7 [total protein (g/L): 63.05±5.79 vs. 59.02±6.63, albumin (g/L): 40.40±5.26 vs. 37.66±4.63, hemoglobin (g/L): 133.33±12.58 vs. 123.80±22.12, all P < 0.05]. In terms of gastrointestinal complications, the incidence of stress ulcer in the UEEN group within 14 days after admission was significantly lower than that in the EEN group [12.5% (4/32) vs. 31.3% (10/32), P < 0.05], but there was no statistically significant difference in feeding intolerance symptoms between the two groups. In terms of neurological recovery and long-term prognosis, GCS scores and Barthel index scores of 14 days after admission were higher than those of 1 day after admission, but there was no statistical significance between the two groups. Six months after surgery, Glasgow outcome scale (GOS) and Barthel index score of the UEEN group were significantly higher than those of the EEN group (GOS score: 3.81±1.06 vs. 3.18±1.07, Barthel index score: 60.78±7.24 vs. 54.52±5.13, both P < 0.05). UEEN support can improve the nutritional level of young and middle-aged postoperative patients with cerebral hemorrhage, reduce the occurrence of postoperative gastrointestinal complications, promote the recovery of neurological function, and improve the long-term prognosis.

Sex-specific modulation of renal epigenetic and injury markers in aging kidney.

Sex differences in renal physiology and pathophysiology are now well established in rodent models and in humans. Epigenetic programming is known to be a critical component of renal injury, as studied mainly in male rodent models; however, not much is known about the impact of biological sex and age on the kidney epigenome. We sought to determine the influence of biological sex and age on renal epigenetic and injury markers, using male and female mice at 4 mo (4M; young), 12 mo (12M), and 24 mo (24M; aged) of age. Females had a significant increase in kidney and body weights and serum creatinine levels and a decrease in serum albumin levels from 4M to 24M of age, whereas minor changes were observed in male mice. Kidney injury molecule-1 levels in serum and renal tissue greatly enhanced from 12M to 24M in both males and females. Circulating histone 3 (H3; damage-associated molecular pattern molecules) levels extensively increased with age; however, males had higher levels than females. Overall, females had markedly high histone acetyltransferase (HAT) activity than age-matched males. Aged mice had decreased HAT activity and increased histone deacetylase activity than sex-matched 12M mice. Aged females had substantially decreased renal H3 methylation at lysine 9 and 27 and histone methyltransferase (HMT) activity than aged male mice. Antiaging protein Klotho levels were significantly higher in young males than age-matched females and decreased substantially with age in males, whereas epigenetic repressor of Klotho, trimethylated H3K27, and its HMT enzyme, enhancer of zeste homolog 2, increased consistently with age in both sexes. Moreover, nuclear translocation and activity of proinflammatory transcription factor nuclear factor-κB (p65) were significantly higher in aged mice. Taken together, our data suggest that renal aging lies in a range between normal and diseased kidneys but may differ between female and male mice, highlighting sex-related differences in the aging process.NEW & NOTEWORTHY Although there is evidence of sex-specific differences in kidney diseases, most preclinical studies have used male rodent models. The clinical data on renal injury have typically not been stratified by sex. Our findings provide convincing evidence of sex-specific differences in age-regulated epigenetic alterations and renal injury markers. This study highlights the importance of including both sexes for better realization of underlying sex differences in signaling mechanisms of aging-related renal pathophysiology.

Diagnosis and Treatment of Membranous Nephropathy in Integrative Medicine

Membranous nephropathy (MN) is a common glomerular disease. The related pathological changes are primarily characterized by the deposition of immune complexes beneath the epithelial cells of the glomerular basement membrane, accompanied by diffuse thickening of the basement membrane. Its etiology and pathogenesis are not fully understood yet; however, they are associated with genetics, infections, tumors, drugs, heavy metals poisoning, environmental pollution, and the loss of immune tolerance. Over 10 target antigens, including the phospholipase A2 receptor (PLA2R) and thrombospondin type 1 domain containing 7A (THSD7A), associated with MN have been identified, each having different clinical implications. Clinical manifestations of MN patients mainly include proteinuria and nephrotic syndrome, with a propensity to form thrombi. Its diagnostic accuracy can be enhanced by combining clinical manifestations, serum antibody testing, and renal biopsy. Proteinuria, estimated glomerular filtration rate (eGFR), and PLA2R antibody levels are vital for the prognostic risk stratification of MN. Low-risk patients primarily undergo non-immunosuppressive treatment (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin II receptor blocker [ARB], sodium-glucose cotransporter 2 inhibitor [SGLT2i], anticoagulants, and traditional Chinese medicine [TCM] treatments), while high-risk patients need to consider using steroids and immunosuppressants, such as cyclophosphamide (CTX), calcineurin inhibitors (CNIs), and anti-cluster of differentiation 20 (anti-CD20) monoclonal antibodies. TCM holds that MN is the imbalance of Fei (lung), Pi (spleen), and Shen (kidney) function, leading to the generation of Neixie such as Shi, Re, Du, and Yu. This disease is difficult to heal because of Shire and Yu. The treatment is based on the use of Jianpi Bushen, simultaneously emphasizing the use of drugs for Qingre Qushi Huoxue. Dialectical use of TCM can obviously improve the clinical response rate and alleviate symptoms such as edema and fatigue by increasing the serum albumin level more rapidly while introducing fewer adverse reactions. Combined with Western medicine, TCM can also reduce toxicity and increase efficiency. This article systematically reviews the etiology, podocyte antigens, clinical manifestations, diagnostic approaches, risk assessment, and integrative medicine therapeutic strategies for MN, aiming to deepen the understanding of MN and guide clinical practice.

215. MALNUTRITION AND VITAMIN DEFICIENCIES AFTER ONCOLOGICAL GASTRIC OR ESOPHAGEAL RESECTION

Abstract Background Patients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation. preoperative malnutrition has been shown to be associated with a higher risk of perioperative complications. In addition, malnutrition has shown to be an independent risk factor for reduced survival in cancer patients and early cancer recurrence. Methods This meta-analysis examines the prevalence of postoperative malnutrition, vitamin, and micronutrient deficiencies in patients who underwent gastrectomy or esophagectomy. A computer-based literature search was performed in several different databases with the The following search terms were used: vitamin, nutrition, deficienc*, malnutrition, osteoporos*, sarcopenia, esophagectom*, oesophagectom*, gastrectomy*, gastric, surg*, resect*, operat*, removal, excision, neoplas*, tumor, tumour, cancer, malign*adenocarcinom* squamous cell carcinom*. Out of 1611 studies, 42 documented relevant information, but only 17 provided 95% confidence intervals. After excluding seven studies due to insufficient data, the meta-analysis included 947 patients from 10 studies. Results The studies recorded vitamin and micronutrient blood levels from 3 months to 10 years post-surgery. The analysis found significant deficiencies in 25-OH Vitamin D3, Vitamin B12, and Serum Calcium levels. Patients had significantly lower Vitamin D3 levels compared to the healthy population, with mean levels in the lower normal range or lower. Serum Calcium levels were also significantly lower than the mean levels of the healthy population but stayed within the normal range. Mean Serum B12 levels were significantly lower than mean B12 levels in the standard population, but standard deviations stayed within the normal range. Serum albumin levels showed no signs of deficiency when compared to the healthy population. Similarly, no deficiency was detected in serum ferritin levels. Other vitamins and micronutrients studies included serum phosphorous, Vitamin A and Vitamin E, but data was insufficient for metanalysis. Discussion The study underscores the need for further research and guidelines to address postoperative nutritional deficiencies in these patients. Particularly, patients often develop a deficiency in Vitamin D3 after surgery, despite supplementation. Vitamin D3 insufficiency may increase perioperative risk and is concerning given the reduced calcium levels and bone marrow density. In conclusion there is a clear need for Vitamin D3 supplementation, both postoperatively and during the perioperative period. The study supports previous data indicating a high prevalence of postoperative micronutrient deficiency in esophagectomy patients. Given the high risk of malnutrition, screening should be a routine part of follow-up care. More data, particularly regarding deficiencies and supplementation after esophagectomy, is necessary.

Serum Albumin and Its Influence on Immediate Outcomes in Children with Congenital Heart Disease Undergoing Cardiac Surgery

Background: Hypoalbuminemia is associated with morbidity and mortality in critically ill children and is a well-recognized predictor of general surgical risk. It frequently occurs in patients with congenital heart disease (CHD). Moreover, cardiopulmonary bypass (CPB)-induces an inflammatory response, and the overall surgical stress can affect albumin concentration greatly Objective: To estimate pre-operative, per-operative and post-operative serum albumin level and to see its influence on immediate outcomes in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass Methods: This cross-sectional observational study was conducted in Paediatric cardiology department, BSMMU in a view to find out the influence of pre-operative, per-operative and post-operative serum albumin level on immediate outcomes in children with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass(CPB).The study included total 48 patients of CHD who underwent CPB. Patients were selected according to inclusion and exclusion criteria. Result: Mean pre-operative serum albumin was 3.5±0.9 mg/dl whereas per-operative and post-operative serum albumin was 3.3±0.7mg/dl and 3.1±0.7 mg/dl respectively.CPB time was a bit higher in study population (98.4± 29.1min) where as other outcome parameters were within normal range. Duration of hospital stay was 12.2±3.1days. 22 patient (45.8%) developed valvular regurgitation and 6 patient (12.5%) developed pericardial effusion in post-operative echocardiography. Infection was evident by positive blood culture in 7 patients (14.8%). Pre, per and post-operative hypoalbuminaemia was associated with poor outcome after CPB. Conclusion: Pre, per and post-operative hypoalbuminaemia is a prudent indicator for speculating poor immediate outcome following CPB in children with CHD. (Bangladesh Heart Journal 2024; 39(2): 121-126

Impact of an oral nutritional supplement on nutritional status in older adults with malnutrition: A randomized controlled trial

Background: The aging population is expanding at an unprecedented rate, leading to a significant increase in the prevalence of malnutrition among older adults. Oral Nutritional Supplements (ONS) have emerged as a widely accepted strategy to address the nutritional needs of this demographic. Objective: This study aimed to evaluate the impact of an ONS on the nutritional status of malnourished older adults. Methods: This was an open-label, randomized-controlled, parallel-group, single-centered study. Recruitment criteria were age ≥60 years, and mini nutrition assessment-short form (MNA-SF) score ≤11. A total of 50 participants were randomly assigned to the intervention (IG) and control (CG) groups (1:1 ratio). The IG received 200 mL of ONS as a bedtime drink for 12 weeks, while the CG received 200 mL of water. Nutrition status, biochemical analysis, and dietary assessment were performed at the beginning and end of the study. Results: Forty-two participants (IG: n=20, and CG: n=22) completed the study. After 12 weeks, the IG showed a significant improvement in the MNA-SF score (p&lt;0.001) compared to the CG (p=0.118). The IG experienced a substantial increment in the vitamin D level (p=0.002). No significant improvements were found in the serum albumin and haemoglobin levels in either group. The intervention led to significant increases in daily intake of energy (p&lt;0.001), carbohydrate (p=0.013), protein (p&lt;0.001), and fat (p&lt;0.001) in comparison to the control group. Conclusion: Supplementing with an ONS, along with a regular diet, significantly improved nutritional status, some biochemical parameters, and daily intake of energy and macronutrients in older adults with malnutrition.

Interferon regulatory factor 1 mediated inhibition of Treg cell differentiation induces maternal-fetal immune imbalance in preeclampsia

The establishment and maintenance of a successful pregnancy rely heavily on maternal-fetal immune tolerance. Inflammatory and immune mechanisms during pregnancy bear a resemblance to those observed in tumor progression, with Treg cells exhibiting similar immunoregulatory functions in both contexts. Interferon regulatory factor 1 (IRF1) is implicated in modulating the immune milieu within tumors and influencing regulatory T (Treg) cell differentiation. However, the precise association between IRF1 and the onset of preeclampsia (PE) remains unclear. In our investigation, we identified trophoblasts as a significant source of IRF1 expression at the maternal-fetal interface through immunofluorescence analysis. Moreover, heightened levels of IRF1 expression were detected in both placental tissues and peripheral blood samples obtained from PE patients, concomitant with an imbalance in the Th17/Treg ratio. In the peripheral circulation, a notable inverse correlation was observed between IRF1 mRNA levels and Foxp3 mRNA, a transcription factor specific to Treg cells. IRF1 mRNA expression showed a positive association with systolic blood pressure and a negative association with serum albumin levels. Furthermore, co-culturing naïve T cells with supernatants from HTR-8/SV neo cells overexpressing IRF1 resulted in diminished differentiation of T cells into Treg cells. In summary, our study indicates elevated IRF1 expression in the peripheral blood and trophoblast cells of PE patients. Elevated IRF1 in trophoblast cells hinders the differentiation of maternal Treg cells, disrupting maternal-fetal immune tolerance and contributing to PE pathogenesis. Additionally, IRF1 expression correlates with disease severity, suggesting its potential as a novel sensitive target in PE.