Acute Kidney Injury in Hospitalized Patients with COVID-19: Risk Factors and Serum Biomarkers.

BACKGROUND: AKI is one of the COVID-19 complications with high prognostic significance. In our research, we studied the prognostic role of several biomarkers that could help us understand AKI pathogenesis in patients with COVID-19. METHODS: We evaluated the medical data of 500 patients hospitalized with COVID-19 in Tareev Clinic from 5 October 2020 to 1 March 2022. The diagnosis of COVID-19 was confirmed with positive RNA PCR in nasopharyngeal swabs and/or typical radiological findings on CT scans. Kidney function was assessed in accordance with KDIGO criteria. In the selected 89 patients, we evaluated serum levels of angiopoetin-1, KIM-1, MAC, and neutrophil elastase 2 and their prognostic significance. RESULTS: The incidence of AKI in our study was 38%. The main risk factors for kidney injury were male sex, cardiovascular diseases, and chronic kidney disease. High serum angiopoetin-1 levels and a decrease in blood lymphocyte count and fibrinogen level also increased the risk of AKI. CONCLUSIONS: AKI is an independent risk factor for death in patients with COVID-19. We propose the prognostic model of AKI development, which includes the combination of serum levels of angiopoetin-1 and KIM-1 on admission. Our model can help to prevent AKI development in patients with coronavirus disease.

Assessment of academic achievements in m-learning.

The paper analyzes the teaching experiment regarding the use of mobile apps in the assessment of student learning. The study involved survey and self-description methods offered to students and instructors to assess the effectiveness of using mobile apps in learning. The study was conducted among 320 s-year students of the I.M. Sechenov First Moscow State Medical University and 8 instructors between September 1 and December 28, 2021, during the academic semester. Socrative and Plickers apps have been found to contribute to: better learning (φ* = 8.94, p ≤ 0.01); developing cognitive motivation among students resulting from diverse learning resources used with apps (φ* = 7.6, p ≤ 0.01); convenience of learning activities because students can work with the app both in the classroom and at home (φ* = 13.66, p ≤ 0.01); improved digital competence (φ* = 2.4, p ≤ 0.05). The research findings can be used by instructors in universities and secondary schools. Since didactic opportunities offered by mobile apps are quite significant, and considering other positive results of their use, this technology may be considered as an important tool for training young people and strengthening their cognitive motivation.

Soy Protein as a Part of a Low-protein Diet is a New Direction in Cardio- and Nephroprotection in Patients With 3b-4 Stages of Chronic kidney Disease.

It has been established that the use of a low-protein diet (LPD) in combination with ketoanalogues of essential amino acids (KA) can contribute to cardio and nephroprotection in chronic kidney disease (CKD). Moreover, it has been shown that partial replacement of the animal protein with soy protein (SP) in the diet contributed to more pronounced nephro and cardioprotection in CKD, however, the data, available in the literature, are mainly represented by experimental studies. AIM OF THE STUDY: We conducted a prospective randomized controlled clinical study that compared the effects of 2 types of diets on the main parameters of nephro and cardioprotection in patients with CKD. MATERIALS AND METHODS: The study included 85 CKD 3b-4 stages G3b-4 patients, compliant to LPD (0.6 g of protein/kg of body weight) + KA (1 tablet/5 kg of body weight). 43 patients (Group 1) received LPD with substitution of animal protein with soy (60% SP + 40% of other vegetable proteins) + KA, and 42 patients (control group (Group 2) received conventional LPD (60% animal protein +40% of vegetable protein) + KA, within 12 months. RESULTS: Substitution of animal protein with SP in diet of patients with CKD to a greater extent delayed the decrease in eGFR (-5.9% vs -11.3%, P = .048), the increase in left ventricle hypertrophy (+4.7% vs +12.3%, P = .042), as well as the increase in central systolic blood pressure (+2.6% vs +13.0%, P = .021), augmentation index (+7.6% vs +23.3%, P = .010), slowed down the decrease in lean body mass in males (+0.9% vs -11.2%, P = .017) and females (-1.8% vs -10.3%, P = .024), increase in phosphorus (-10.3% vs +13.0%, P = .029), cholesterol (-10.7% vs -3.4% P = .047) and urea (+6.3% vs +19.6%, P = .035) serum levels. CONCLUSION: The use of LPD with substitution of animal protein with SP + KA provides more pronounced effect on nephro and cardioprotection as well as maintenance of nutritional status, than conventional LPD + KA in patients with CKD 3b-4 stages.

Cardiovascular remodeling as a result of fibroblast growth factor-23 (FGF-23)/Klotho imbalance in patients with CKD.

BACKGROUND: In chronic kidney disease (CKD) cardiovascular remodeling (CVR) is very frequent compared with general population and, as suppose, may be associated with «new¼ renal risk factors. The aim of study was to estimate association of new serum biomarkers (FGF-23, Klotho) and traditional biomarker of cardiac damage-serum Troponin I (sTr-I) with signs of CVR. METHODS: One hundred thirty CKD G1-5D patients without cardiovascular disease (CVD) clinical manifestation were included. We measured serum FGF-23, Klotho and sTr-I. The instrumental methods were: echocardiography, SphygmoCor test [Pulse Wave Velocity (PWV), Central (aortic) Blood Pressure (CBP), Subendocardial Blood Supply (SBS)]. RESULTS: FGF-23 level correlated with: sTr-I (r = 0.512; p < 0.01), eccentric left ventricular hypertrophy, LVH (r = 0.543; p < 0.01), SBS (r = - 0.499; p < 0.05). There were no differences of FGF-23 level in patients with normal and high CBP. Klotho correlated with concentric LVH (r = - 0.451; p < 0.01), PWV (r = - 0.667; p < 0.001), Cardiac Calcification Score, CCS (r = - 0.581; p < 0.01). Multivariate analysis revealed positive independent association of FGF-23 with eccentric LVH (OR = 1.036, 95% CI (1.004-1.068); p = 0.038). Klotho was a negative determinant for concentric LVH (OR = 0.990, 95% CI 0.987-0.994; p < 0.001), increased PWV (OR = 0.984, 95% CI (0.977-0.991); p < 0.001) and CCS (OR = 0.991, 95% CI (0.988-0.995); p < 0.001). In addition, multivariate analysis revealed a relationship between serum Klotho (OR = 0.980, 95% CI (0.964-0.996); p = 0.016), FGF-23 (OR = 3.145, 95% CI (1.020-9.695); p = 0.046) and troponin I level. CONCLUSION: In CKD patients without CVD clinical manifestation increased serum FGF-23 level and decreased Klotho are associated with CVR: FGF-23 with eccentric LVH (independently of CBP), Klotho determinate concentric LVH, PWV and CCS. Moderately elevated sTr-I levels may be a manifestation of FGF-23/Klotho imbalance in CKD.

Effect of essential amino acid кetoanalogues and protein restriction diet on morphogenetic proteins (FGF-23 and Кlotho) in 3b-4 stages chronic кidney disease patients: a randomized pilot study.

BACKGROUND: A low protein diet (LPD) with essential amino acid ketoanalogue supplementation (KA) may contribute in improving of chronic kidney disease (CKD), while the exact mechanisms of KA's effect are not established yet. We have conducted a prospective, randomized, controlled comparative study of LPD + KA and LPD alone in relation to serum Klotho, FGF-23 levels in CKD patients. METHODS: 79 non-diabetic CKD 3b-4 stage patients, compliant with LPD diet (0.6 g/kg of body weight/day), had been selected. The patients were randomized into two groups. The first group (42 patients) received LPD + КA. The second group (37 patients) continued the LРD alone. In addition to routine tests, serum Klotho, FGF-23 levels, as well as bioimpedance analysis, sphygmography (stiffness (augmentation) indices (AI), central (aortal) blood pressure) with a «SphygmaCor¼ device; echocardiography (valvular calcification score (VCS) and LVMMI), were performed. RESULTS: There were body mass indices' decrease (p = 0.046), including muscle body mass in men (p = 0.027) and woman (p = 0.044) in the LPD group to the end of study (14th month). In addition, lower FGF-23 (p = 0.029), and higher sKlotho (p = 0.037) were detected in the LPD + KA group compared to the LPD one. The increase in AI (p = 0.034), VCS (p = 0.048), and LVMMI (p = 0.023) was detected more often in the LPD group at the end of study. CONCLUSION: LPD + KA provides support for nutrition status and contributes to more efficient correction of FGF-23 and Klotho abnormalities that may result in cardiovascular calcification and cardiac remodeling decreasing in CKD. At the same time, a prolonged LPD alone may lead to malnutrition.

Phosphonium-iodonium ylides with heteroatomic groups in the synthesis of annelated P-containing heterocycles.

The preparation and chemistry of novel sulfonyl- and phosphoryl-derived λ(3)-iodanes are reported. These compounds with three different heteroatoms attached to a negatively charged C atom represent potentially useful reagents that combine in one molecule the synthetic advantages of a phosphonium ylide and an iodonium salt. Specifically, they can react with a number of acetylenes, leading to hitherto unknown sulfonyl- and phosphoryl-substituted phosphinolines, phosphininothiophenes, and a novel type of annelated P-containing heterocycle--phosphininopyrazole.

Hetaryl-substituted phosphonium-iodonium ylides in synthesis of heterocycles.

A series of hitherto unknown hetaryl-substituted (in phosphonium part) phosphonium-iodonium ylides were synthesized. The reaction of these mixed phosphonium-iodonium ylides with acetylenes opens a way to new furyl annelated phosphinolines or unusually substituted phosphininofurans.

Photochemical synthesis of phosphinolines from phosphonium-iodonium ylides.

We describe three different series of experiments which were undertaken to test our hypothesis that during irradiation of phosphonium-iodonium ylides (1a, 1b) an electrophilic carbene is generated. By opposing the assumed intermediate to monosubstituted alkynes, we observed in the case of electron-rich substituents at the triple bond a domination of a 1,3-dipolar cycloaddition of the intermediate with the triple bond to yield furans. In the case of electron poorer substituents, the formation of phosphinolines prevails. A second series of experiments was carried out with mixed ylides in which one phenyl ring at the triarylphosphonium group was replaced by a thienyl group. In this case, we observe only an intramolecular reaction with the thienyl ring to yield the phosphinolines 21-23. In a third test, we replaced in the mixed ylides 1a, 1b the COR group by a CN substituent. This modification leads to phosphinolines only and avoids a 1,3-dipolar cycloaddition.