Aluminum overload in the reverse osmosis dialysis era: does it exist?

BACKGROUND: Aluminum accumulation is a well-described complication in dialysis patients. Improvements in hemodialysis technology have possibly eliminated the occurrence of aluminum overload. Limited evidence suggests that aluminum overload may decline in the era of aluminum removal from dialysis fluids, even with the use of aluminum binders. METHODS: We examined the data from January 2014 to June 1, 2020, identified through our electronic records, to evaluate the desferrioxamine (DFO) test results for aluminum overload. The presentation and treatment of aluminum overload were recorded. RESULTS: Ninety-nine dialysis patients were enrolled for the DFO test. Forty-seven patients (47.5%) were identified as DFO test positive for aluminum overload, of which 14 (14/47) patients had symptoms, including one patient with an unexplained fracture, eight patients with unexplained anemia despite high-dose erythropoiesis-stimulating agents, and five patients with hypercalcemia (serum calcium >11 mg dL-1). None of the patients with aluminum overload developed encephalopathy. Only four of the 47 patients had microcytic anemia. Patients requiring longer treatments (>10 months versus <10 months) had similar basal serum aluminum (p = 0.219) but had an increase in serum aluminum after DFO (p = 0.041). Furthermore, the treatments decreased erythropoietin doses in the aluminum overload group, with serum total alkaline phosphatase levels <60 U L-1 (p = 0.028). CONCLUSION: We concluded that aluminum overload existed in the reverse osmosis dialysis era. In light of non-obvious symptoms, such as anemia and bone turnover change, serum aluminum in dialysis patients should be monitored in countries using aluminum-based phosphate binders, despite reverse osmosis dialysis.

Incidental finding of situs ambiguus in a middle-aged woman.

Situs ambiguus is a rare congenital abnormality with outcomes ranging from asymptomatic to fatal. Here we present a woman with an incidental finding of situs ambiguus hinted by her chest radiograph. This case highlights the importance of actively seeking diagnosis when right sub-diaphragmic air is noted when viewing a chest radiograph.

Investigation of clinical predictors of survival in idiopathic pulmonary fibrosis patients: A cohort study in Taiwan.

BACKGROUND: Two antifibrotic medications, pirfenidone and nintedanib, have been approved as treatments for idiopathic pulmonary fibrosis (IPF)-a life-threatening interstitial lung disease. However, there are insufficient current data regarding clinical predictors of survival for patients with IPF in the era of antifibrotics. METHODS: We retrospectively analyzed the medical records of patients with IPF treated between April 2017 and May 2020. Univariate and multivariate Cox proportional hazard models were used to identify independent predictors of mortality among these patients with IPF. RESULTS: A total of 40 patients with IPF (average age, 75.58 ± 8.34 years) were included in the study, 27 (67.5%) of whom were treated with antifibrotic drugs. In the entire cohort, 14 (35%) patients died, and the overall survival of the study population was 48.52 ± 5 months (median, not applicable [NA] [29-NA] months). The univariate and multivariate Cox proportional hazard models indicated that chest tightness, finger clubbing, acute exacerbation after medication, decreased percentage forced vital capacity (%FVC), and decreased percentage 1-second forced expiratory volume were clinical factors linked to all-cause mortality among all patients, although without statistical significance at the multivariate level. Meanwhile, only finger clubbing was a significant mortality predictor among patients who received antifibrotic medications. A mortality scoring system was built upon the aforementioned risk factors, with the exclusion of %FVC, whose individual mortality score was nearly zero. CONCLUSION: Chest tightness, finger clubbing, acute exacerbation after medication, and decreased %FVC were clinical factors associated with mortality in patients with IPF, although without statistical significance. A scoring system including these factors can be used to predict all-cause mortality in patients with IPF. The mere intake of antifibrotic medications was not a significant mortality predictor in this study. This might be owed to the retrospective nature of the study, where many patients started the medications after the deterioration of their pulmonary function rather than from the start.

Vegetarian diet in dialysis patients: A significant gap between actual intake and current nutritional recommendations.

ABSTRACT: Nutritional status is a predictor of mortality and morbidity in dialysis patients. This study aimed to assess dietary behaviors in dialysis patients compared to the recommendations of the Kidney Disease Outcomes Quality Initiative.Ninety five dialysis patients recruited from a hospital completed a 24-hour dietary recall questionnaire. Body weight, energy requirements, protein requirements, albumin, normalized protein catabolic rate, and 25(OH) vitamin D levels were measured.Of the 95 patients, 11 (11.6%) were below the desirable body mass index range, 59 (62.1%) were within the desired range, and 25 (26.3%) were above the desired range. However, only 32.7% of patients met the target energy intake, 29.5% reached the protein intake target, and 20.0% had adequate vitamin D concentrations. Vegetarian patients had lower energy, protein, fat, vitamin D intake, lower body mass index, serum blood urea nitrogen, creatinine, phosphate, normalized protein catabolic rate, and vitamin D status than the omnivorous patients (P < .05). After adjusting for age, sex, and body weight, vegetarianism was an independent risk factor for severe vitamin D deficiency (<10 ng/ml, P < .01).Most dialysis patients do not meet their dietary recommendations or goals. The risk of a vegetarian diet may outweigh the benefits in dialysis patients. Careful consideration of dietary behaviors is required for dialysis patients to prevent malnutrition, more so in vegetarians.

Advanced Lung Adenocarcinoma Patient with ERBB2 Amplification Identified by Comprehensive Genomic Profiling Benefits from Trastuzumab.

For non-small-cell lung cancer (NSCLC) patients without established actionable alterations in genes such as EGFR or ALK, options for targeted therapy remain limited in clinical practice. About 5% of lung adenocarcinoma patients have tumors with ERBB2 genetic alterations, with even fewer patients harboring ERBB2 amplification. Currently, clinical trials mainly use IHC, FISH, or mutation testing to identify potential responders to ERBB2-targeting agents. The use of next-generation sequencing (NGS) to detect ERBB2 alterations, including copy number variants, is rare. In this study, we present an EGFR- and ALK-negative advanced NSCLC case for which we conducted comprehensive tumor genomic profiling to identify potentially actionable alterations. The tumor harbored an ERBB2 amplification, and trastuzumab-based therapy resulted in an excellent response, with a necrotic regression of the patient's lung lesion. Although he developed brain metastasis four months after trastuzumab initiation, he survived for an additional period of eight months without local recurrence or other systemic metastasis. This case report shows that the use of comprehensive genetic testing enables the identification of rare actionable alterations in NSCLC patients without other options for targeted treatment.

Green Fabrication of Supported Platinum Nanoparticles by Supercritical CO2 Deposition.

Pt nanoparticles were successfully deposited on uncatalyzed carbon paper by the supercritical CO2 deposition (SCD) method using platinum (II) acetylacetonate as a precursor followed by thermal conversion. A full 24 factorial design (four factors, each with two levels) was used to investigate the main effect of four factors (deposition temperature, deposition time, reduction temperature, and reduction time) and the interaction effects between them. The morphological structures and surface properties of the Pt/carbon paper composite were analyzed by X-ray diffraction (XRD), scanning electron microscope (SEM)/energy-dispersive X-ray spectroscopy analyzer (EDS), and high-resolution transmission electron microscopy (HR-TEM). The results of the 24 factorial design showed that Pt loading on the substrate correlated significantly with deposition time, while Pt aggregation slightly increased with the thermal reduction temperature. Data obtained from both XRD and HR-TEM were in good agreement and showed that Pt nanoparticles were homogeneously dispersed on the substrate with diameters of 7.2⁻8.7 nm.

Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study.

BACKGROUND & OBJECTIVES: Cardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects of a vegetarian diet on the nutritional and cardiovascular status of dialysis patients. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: A study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls was conducted in the Kaohsiung Veterans General Hospital. Brachial-ankle pulse wave velocity and biochemistry data including total homocysteine levels, serum lipid profiles, high-sensitivity C-reactive protein, vitamin D levels, albumin, and normalized protein catabolic rate were measured. RESULTS: Compared with the non-vegetarian control group, vegetarian subjects had lower body weight, body mass index, serum phosphate, blood urea nitrogen, serum creatinine, vitamin D, uric acid, albumin, and normalized protein catabolic rate (p < 0.05). The vegetarian group showed higher brachial-ankle pulse wave velocity than the non-vegetarian group (1926.95 ± 456.45 and 1684.82 ± 309.55 cm/sec, respectively, p < 0.05). After adjustment for age, albumin, pre-dialysis systolic blood pressure, and duration of dialysis, vegetarian diet remained an independent risk factor for brachial-ankle pulse wave velocity. CONCLUSIONS: The present study revealed that patients on dialysis who follow vegetarian diets may experience subclinical protein malnutrition and vitamin D deficiency that could offset the beneficial cardiovascular effects of vegetarianism.

Calpains mediate the proteolytic modification of human cytomegalovirus UL112-113 proteins.

The human cytomegalovirus (HCMV) UL112-113 gene is implicated in lytic viral replication. The UL112-113 proteins p34, p43, p50 and p84 are expressed via alternative splicing. However, the mechanism for the generation of three additional virus-associated proteins (p20, p26 and p28), which share the UL112 reading frame, remains unknown. Bioinformatic analyses indicated that p34, p43, p50 and p84 contain potential PEST-like degradation motifs. In this study, inhibitors of calpains, lysosomes and proteasomes reduced p20, p26 and p28 levels in virus-infected cells, suggesting the involvement of proteolytic modification. Moreover, maitotoxin, which increases intracellular calcium levels and activates calpain activity, induced the intracellular proteolysis of p34 into p20, p26 and p28 and the cleavage of p43, p50 and p84 into p38 and a novel protein, p34c. Proteolytic assays further indicated that p34, p43, p50 and p84 were substrates of calpain-1 and calpain-2 and that they generated proteolytic products that corresponded to those detected during the HCMV infectious period. Furthermore, substitution mutations in the putative calpain cleavage sites of p34 reduced accumulation of proteolytic products. The knockdown of endogenous calpain-1 and calpain-2 by RNA interference reduced accumulation of p20, p26 and p28 and concurrently increased levels of nascent p43, p50 and p84 during the infectious cycle. Intriguingly, calpain depletion enhanced viral genome synthesis. Moreover, HCMV-permissive cells that stably expressed p20, p26 or p28 exhibited reduced viral genome synthesis and mature virus production. Our findings suggest that cognate UL112-113 proteins derived from calpain-catalysed proteolysis are involved in the HCMV replication process.

The chemical and biological characteristics of coke-oven wastewater by ozonation.

A bench-scale bubble column reactor was used to investigate the biological and chemical characteristics of coke-oven wastewater after ozonation treatment through the examination of selected parameters. Color and thiocyanate could be removed almost entirely; however, organic matter and cyanide could not, due to the inadequate oxidation ability of ozone to remove ozonated byproducts under given experimental conditions. The removal of cyanide and total organic carbon were pH-dependent and were found to be efficient under neutral to alkaline conditions. The removal rate for thiocyanate was about five times that of cyanide. The ozone consumption ratio approached to about 1 at the early stage of ozonation (time <20 min), indicating that easily degraded matter was present, and mostly ozone was used to oxidize the pollutants. As ozonation progressed, the consumption ratio decreased to 0.2, and TOC removal (eta(TOC)) increased to 30%, indicating that easily degraded pollutants were degraded almost entirely. The effect of ozonation on the subsequent biological treatment unit (i.e., activated sludge process) was determined by observing the ratio of 5-day biological oxygen demand to chemical oxygen demand (BOD(5)/COD) and the specific oxygen utilization rate (SOUR). The results indicated that the contribution of ozonation to inhibition reduction was very significant but limited to the enhancement of biodegradation. The operation for ozonation of coke-oven wastewater was feasible under neutral condition and short ozone contact time in order to achieve better performance and cost savings.

The decolorization and mineralization of acid orange 6 azo dye in aqueous solution by advanced oxidation processes: a comparative study.

The comparison of different advanced oxidation processes (AOPs), i.e. ultraviolet (UV)/TiO(2), O(3), O(3)/UV, O(3)/UV/TiO(2), Fenton and electrocoagulation (EC), is of interest to determine the best removal performance for the destruction of the target compound in an Acid Orange 6 (AO6) solution, exploring the most efficient experimental conditions as well; on the other hand, the results may provide baseline information of the combination of different AOPs in treating industrial wastewater. The following conclusions can be drawn: (1) in the effects of individual and combined ozonation and photocatalytic UV irradiation, both O(3)/UV and O(3)/UV/TiO(2) processes exhibit remarkable TOC removal capability that can achieve a 65% removal efficiency at pH 7 and O(3) dose=45mg/L; (2) the optimum pH and ratio of [H(2)O(2)]/[Fe(2+)] found for the Fenton process, are pH 4 and [H(2)O(2)]/[Fe(2+)]=6.58. The optimum [H(2)O(2)] and [Fe(2+)] under the same HF value are 58.82 and 8.93mM, respectively; (3) the optimum applied voltage found in the EC experiment is 80V, and the initial pH will affect the AO6 and TOC removal rates in that acidic conditions may be favorable for a higher removal rate; (4) the AO6 decolorization rate ranking was obtained in the order of O(3)