Miracle-dz/UniFAR-FTUs huggingface dataset:
Dietary Protein and Potassium, Diet-Dependent Net Acid Load, and Risk of Incident Kidney Stones.

BACKGROUND AND OBJECTIVES Protein and potassium intake and the resulting diet-dependent net acid load may affect kidney stone formation. It is not known whether protein type or net acid load is associated with risk of kidney stones. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We prospectively examined intakes of protein (dairy, nondairy animal, and vegetable), potassium, and animal protein-to-potassium ratio (an estimate of net acid load) and risk of incident kidney stones in the Health Professionals Follow-Up Study (n=42,919), the Nurses' Health Study I (n=60,128), and the Nurses' Health Study II (n=90,629). Multivariable models were adjusted for age, body mass index, diet, and other factors. We also analyzed cross-sectional associations with 24-hour urine (n=6129). RESULTS During 3,108,264 person-years of follow-up, there were 6308 incident kidney stones. Dairy protein was associated with lower risk in the Nurses' Health Study II (hazard ratio for highest versus lowest quintile, 0.84; 95% confidence interval, 0.73 to 0.96; P value for trend <0.01). The hazard ratios for nondairy animal protein were 1.15 (95% confidence interval, 0.97 to 1.36; P value for trend =0.04) in the Health Professionals Follow-Up Study and 1.20 (95% confidence interval, 0.99 to 1.46; P value for trend =0.06) in the Nurses' Health Study I. Potassium intake was associated with lower risk in all three cohorts (hazard ratios from 0.44 [95% confidence interval, 0.36 to 0.53] to 0.67 [95% confidence interval, 0.57 to 0.78]; P values for trend <0.001). Animal protein-to-potassium ratio was associated with higher risk (P value for trend =0.004), even after adjustment for animal protein and potassium. Higher dietary potassium was associated with higher urine citrate, pH, and volume (P values for trend <0.002). CONCLUSIONS Kidney stone risk may vary by protein type. Diets high in potassium or with a relative abundance of potassium compared with animal protein could represent a means of stone prevention.
Conservative versus Operative Management of Complex Proximal Humeral Fractures: A Meta-analysis

Background The optimal management of complex proximal humeral fractures is debatable. The present study uses meta-analytical techniques to compare conservative and operative management of proximal humeral fractures with respect to morbidity and functional outcomes. Methods Studies published between 1970 and 2007 comparing conservative and operative treatment of proximal humeral fractures were included. The end points evaluated were morbidity and functional outcomes. A random effects model was used and sensitivity analysis was performed to account for bias in patient selection. Results Ten studies matched the selection criteria, reporting on 486 patients. Two hundred and nineteen (45%) were managed conservatively, 174 (36%) underwent operative fixation and 93 (19%) underwent hemiarthroplasty. Mean follow-up ranged from 6 months to 156 months. No significant difference was demonstrated in post-treatment Constant scores (weighted mean difference = 1.62, –7.12, 10.36), rate of avascular necrosis [odds ratio (OR) = 0.92, confidence interval (CI) = 0.37–2.30] ongoing pain or non-union (OR = 1.28, CI = 0.11–15.46) between the groups. These findings remained consistent when considering studies matched for three- and four-part fractures and fracture dislocations. Conclusion On the basis of available comparative data, there is no demonstrable difference in outcomes between fractures managed surgically or conservatively. There is a need for large, randomised trials to guide management of these fractures.
Genotype analysis for ΔF508, G551D and R553X mutations in children and young adults with cystic fibrosis with and without chronic liver disease

Genetic factors have been implicated in the pathogenesis of liver disease in cystic fibrosis. To investigate whether liver disease is associated with particular mutations of the defective gene in cystic fibrosis, we have determined the frequencies of three mutations – ΔF508, G551D and R553X – in 111 children and young adults with cystic fibrosis by analysis of genomic DNA segments amplified by the polymerase chain reaction. Twenty‐nine patients had severe liver disease with portal hypertension, 19 had clinical and/or biochemical evidence of liver disease but no associated portal hypertension and 63 had no evidence of liver disease. No significant differences in the frequencies of the ΔF508, G551D or R553X mutations in the three clinical subgroups were found, and we conclude that the development of liver disease in cystic fibrosis is unlikely to be associated with a specific mutation in the gene. However, because 27% of cystic fibrosis chromosomes do not have a defined mutation, this possibility cannot be ruled out. A familial concordance for clinical liver disease of 20% in this study, compared with a reported prevalence of 4.7%, suggests that genes outside the cystic fibrosis locus and/or environmental factors are involved in the pathogenesis of liver disease in cystic fibrosis. (Hepatology 1992;15:660–664).
Determinants of cardiac autonomic dysfunction in ESRD.

BACKGROUND AND OBJECTIVES Cardiovascular events are common in patients with ESRD. Whether sympathetic overactivity or vagal withdrawal contribute to cardiovascular events is unclear. We determined the general prevalence and clinical correlates of heart rate variability in patients on hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We collected baseline information on demographics, clinical conditions, laboratory values, medications, physical performance, left ventricular mass (LVM), and 24-hour Holter monitoring on 239 subjects enrolled in the Frequent Hemodialysis Network Daily Trial. RESULTS The mean R-R interval was 812 ± 217 ms. The SD of R-R intervals was 79.1 ± 40.3 ms. Spectral power analyses showed low-frequency (sympathetic modulation of heart rate) and high-frequency power (HF; vagal modulation of heart rate) to be 106.0 (interquartile range, 48.0 to 204 ms(2)) and 42.4 ms(2) (interquartile range, 29.4 to 56.3 ms(2)), respectively. LVM was inversely correlated with log HF (-0.02 [-0.0035; -0.0043]) and the R-R interval (-1.00 [-1.96; -0.032]). Physical performance was associated with mean R-R intervals (1.98 [0.09; 3.87]) and SD of R-R intervals (0.58 [0.049; 1.10]). After adjustment for age, race, ESRD vintage, diabetes, and physical performance, the relationship between log HF and LVM (per 10 g) remained significant (-0.025 [-0.042; -0.0085]). CONCLUSIONS Holter findings in patients on hemodialysis are characterized by sympathetic overactivity and vagal withdrawal and are associated with higher LVM and impaired physical performance. Understanding the spectrum of autonomic heart rate modulation and its determinants could help to guide preventive and therapeutic strategies.
The cost-effectiveness of using payment to increase living donor kidneys for transplantation.

BACKGROUND AND OBJECTIVES For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. RESULTS Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. CONCLUSION Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.
Longitudinal study of small solute transport and peritoneal protein clearance in peritoneal dialysis patients.

BACKGROUND AND OBJECTIVES Peritoneal protein clearance (Pcl) is determined by both effective (small pores) membrane area and relative capillary leakiness (large pores). It is not known how these two components change with duration of peritoneal dialysis (PD) in the context of progressive membrane injury and differential attrition of patients with higher Pcl, which has been associated with increased mortality risk in several studies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients treated continuously from 2000 to 2011 for a minimum of 4 years were selected from the longitudinal prospective Stoke PD Study. Pcl, membrane area (peritoneal solute transport rate [PSTR]), dialysis prescription, and residual renal function were measured every 6 months, along with comorbidity and peritonitis events. Multilevel multivariate analysis was used to determine associations with Pcl over time, taking into account within-subject correlations. RESULTS From 280 incident patients, 335 datasets were analyzed from 49 patients receiving treatment for 4 years. Pcl correlated with PSTR at baseline (R=0.61; P<0.01), but over time there was progressive uncoupling of this relationship (year 4, R=0.28; P=0.05) with increasing PSTR (0.66-0.74; P<0.01) and stable Pcl (78.4-81.9 ml/d; P=0.7). Multivariate analysis found that age, PSTR, daily ultrafiltration, and sodium removal were significant predictors of Pcl when adjusted for sex, comorbidity, glucose exposure, and residual renal function. Peritonitis was associated with increased PSTR but a similar pattern of uncoupling. CONCLUSION There is a progressive dissociation of the small- and large-pore pathways with time on PD, which would be in keeping with a switch from local inflammation early on to progressive fibrosis, combined with increased vascular surface area. Measuring longitudinal changes in Pcl may complement membrane function tests used to monitor progressive injury.
Estudo da incontinência urinária em mulheres climatéricas usuárias e não usuárias de medicação anti-hipertensiva

Among other risks factors for urinary incontinence (UI) is the use of antihypertensive medicines. This paper aimed to value the prevalence of urinary incontinence in menopausal women attending in the Family Health Strategy in Bozano/RS and to assess the risk of these medicine use. It is a descriptive, cross-sectional and analytical study with a comparison group, being group 1 (G1) formed by women who use anti-hypertensive medicines and have a body mass index (BMI) <29,9 kg/m², and group 2 (G2) by women with BMI <29,9 kg/m² and no use of anti-hypertensive medicines. The sampling is composed of 70 women, 21 in G1 group and 49 in G2 group. Data collection was a questionnaire addressing issues related to domestic preconditions for women's health, medicine use and uro-gynecological conditions. As for the prevalence of UI, 52.8% had this complaint (21.4% in G1 and 31.4% in G2). Concerning the pharmacological class of anti-hypertensive medicines, angiotensin-conversing enzyme inhibitors are used by 33.3% of women. As for the risk for UI using anti-hypertensive medicines, the odds ratio showed that women who use this medicine are 3.06 times more likely to be incontinent (p = 0,03). The results suggest that the use of antihypertensive medicines is a predictor of UI in the group of women studied.
Adolescents’ Dietary Habits and Attitudes: Unpacking the ‘Problem of (Parental) Influence’

Several interests – policy and research among them – appear aligned in concentrating on the antecedents of young people’s eating habits. Between them they provide a vocabulary for, and convey an implicit model of, antecedents to adolescents’ activities, that can resolve into a simply stated question: what are the influences on young people’s dietary habits and attitudes? This article seeks to unpack/problematize the idea of influence that question contains, limiting attention to one presumed source of influence, that of parents. It aims to illustrate the manner in which the idea of parental influence eludes ready identification by presenting empirical material reporting conceptions of food and eating, of habits and attitudes, and of aspects of domestic life. Via presentation of material on images of household, on young people’s bids for autonomy and independence, parents’ concern and vigilance and features of the divisions of domestic (kitchen) labour, the observation that parent/child relationships are not well characterized as either uni-dimensional or uni-directional is confirmed. Caution is recommended in relying on an idea of influence for research or practical interventions.
Dialysate sodium concentration and the association with interdialytic weight gain, hospitalization, and mortality.

BACKGROUND AND OBJECTIVES Recommendations to decrease the dialysate sodium (DNa) prescription demand analyses of patient outcomes. We analyzed morbidity and mortality at various levels of DNa, simultaneously accounting for interdialytic weight gain (IDWG) and for the mortality risk associated with lower predialysis serum sodium (SNa) levels. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used multiply-adjusted linear mixed models to evaluate the magnitude of IDWG and Cox proportional hazards models to assess hospitalizations and deaths in 29,593 patients from the Dialysis Outcomes and Practice Patterns Study with baseline DNa and SNa as predictors, categorized according to lowest to highest levels. RESULTS IDWG increased with higher DNa across all SNa categories, by 0.17% of body weight per 2 mEq/L higher DNa; however, higher DNa was not associated with higher mortality in a fully adjusted model (also adjusted for SNa; hazard ratio [HR]=0.98 per 2 mEq/L higher DNa, 95% confidence interval [CI] 0.95-1.02). Instead, higher DNa was associated with lower hospitalization risk (HR=0.97 per 2 mEq/L higher DNa, 95% CI 0.95-1.00, P=0.04). Additional adjustments for IDWG did not change these results. In sensitivity analyses restricted to study facilities, in which 90%-100% of patients have the same DNa (56%), the adjusted HR for mortality was 0.88 per 2 mEq/L higher DNa (95% CI 0.83-0.94). These analyses represented a pseudo-randomized experiment in which the association between DNa and mortality is unlikely to have been confounded by indication. CONCLUSIONS In the absence of randomized prospective studies, the benefit of reducing IDWG by decreasing DNa prescriptions should be carefully weighed against an increased risk for adverse outcomes.
Assessment of KDIGO definitions in patients with histopathologic evidence of acute renal disease.

BACKGROUND AND OBJECTIVES AKI is a clinical syndrome with various causes involving glomerular, interstitial, tubular, and vascular compartments of the kidney. Acute kidney disease (AKD) is a new concept that includes both AKI and the conditions associated with subacute decreases in GFR (AKD/non-AKI). This study aimed to investigate the correlation between AKI/AKD defined by clinical presentation and diffuse histologic criteria for acute abnormalities based on renal biopsy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All 303 patients who were histologically diagnosed as having acute tubular necrosis (ATN), acute tubulointerstitial nephritis, cellular crescentic GN, acute thrombotic microangiopathy, or complex lesions on renal biopsy from January 2009 to December 2011 were enrolled in the study. The 2012 Kidney Disease Improving Global Outcomes AKD/AKI definitions were applied to classify patients as follows: AKI, AKD/non-AKI, non-AKD, or unclassified. RESULTS A total of 273 patients (90.1%) met the AKD criteria; 198 patients (65.3%) were classified as having AKI according to serum creatinine (SCr) and urine output criteria. The urine output criteria added 4.3% to the SCr criteria and reclassified 6.7% of the AKI cases into higher stages. Of patients with ATN on pathology, 79.2% met AKI criteria; this was a higher percentage than for those who had other individual pathologic lesions (50%-64%). The major cause of not being defined as having AKI was a slower SCr increase than that required by the definition of AKI (98, 93.3%). Patients with AKI had more severe clinical conditions and worse short-term renal outcome than those in the non-AKI group. CONCLUSIONS Diffuse, acute abnormality defined by renal biopsy and AKI defined by clinical presentation are two different entities. Most patients who have diffuse acute histologic findings met the criteria for AKD, whereas only two thirds met the definition of AKI.
Occupational stress and incidence of sick leave in three sectors of activity of the Belgian workforce: The belstress study

Background: The Karasek-Johnson “Demands-Control-Social support” (DCS) model is one of the most widely used job stress models. It has been largely used to predict a wide range of health outcomes and to a lesser extent absenteeism. Our aim is to test the predictive power of the model in relation with one year incidence of sick leave in three sectors of activity, taking into account a wide range of socio-demographic and behavioural variables. Methods: The baseline survey of the BELSTRESS study was conducted in 25 companies of the secondary, tertiary and public sectors across Belgium between 1994 and 1998. A cohort of 15,557 males
Associations of Left Ventricular Hypertrophy and Geometry with Adverse Outcomes in Patients with CKD and Hypertension.

BACKGROUND AND OBJECTIVES Left ventricular hypertrophy (LVH) and abnormal left ventricular (LV) geometry predict adverse outcomes in the general and hypertensive populations, but findings in CKD are still inconclusive. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled 445 patients with hypertension and CKD stages 2-5 in two academic nephrology clinics in 1999-2003 who underwent both echocardiography and ambulatory BP monitoring. LVH (LV mass >100 g/m(2) [women] and >131 g/m(2) [men]) and relative wall thickness (RWT) were used to define LV geometry: no LVH and RWT≤0.45 (normal), no LVH and RWT>0.45 (remodeling), LVH and RWT≤0.45 (eccentric), and LVH and RWT>0.45 (concentric). We evaluated the prognostic role of LVH and LV geometry on cardiovascular (CV; composite of fatal and nonfatal events) and renal outcomes (composite of ESRD and all-cause death). RESULTS Age was 64.1±13.8 years old; 19% had diabetes, and 22% had CV disease. eGFR was 39.9±20.2 ml/min per 1.73 m(2). LVH was detected in 249 patients (56.0%); of these, 125 had concentric LVH, and 124 had eccentric pattern, whereas 71 patients had concentric remodeling. Age, women, anemia, and nocturnal hypertension were independently associated with both concentric and eccentric LVH, whereas diabetes and history of CV disease associated with eccentric LVH only, and CKD stages 4 and 5 associated with concentric LVH only. During follow-up (median, 5.9 years; range, 0.04-15.3), 188 renal deaths (112 ESRD) and 103 CV events (61 fatal) occurred. Using multivariable Cox analysis, concentric and eccentric LVH was associated with higher risk of CV outcomes (hazard ratio [HR], 2.59; 95% confidence interval [95% CI], 1.39 to 4.84 and HR, 2.79; 95% CI, 1.47 to 5.26, respectively). Similarly, greater risk of renal end point was detected in concentric (HR, 2.33; 95% CI, 1.44 to 3.80) and eccentric (HR, 2.30; 95% CI, 1.42 to 3.74) LVH. Sensitivity analysis using LVH and RWT separately showed that LVH but not RWT was associated with higher cardiorenal risk. CONCLUSIONS In patients with CKD, LVH is a strong predictor of the risk of poor CV and renal outcomes independent from LV geometry.
Association of IL-6 and a functional polymorphism in the IL-6 gene with cardiovascular events in patients with CKD.

BACKGROUND AND OBJECTIVES High serum IL-6 is a major risk factor for cardiovascular disease (CVD) in the general population. This cytokine is substantially increased in patients with CKD, but it is still unknown whether the link between IL-6 and CVD in CKD is causal in nature. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a cohort of 755 patients with stages 2-5 CKD, consecutively recruited from 22 nephrology units in southern Italy, this study assessed the relationship of serum IL-6 with history of CVD, as well as with incident cardiovascular (CV) events (mean follow up±SD, 31±10 months) and used the functional polymorphism (-174 G/C) in the promoter of the IL-6 gene to investigate whether the link between IL-6 and CV events is causal. RESULTS In adjusted analyses, serum IL-6 above the median value was associated with history of CVD (P<0.001) and predicted the incidence rate of CV events (hazard ratio, 1.66; 95% confidence interval [95% CI], 1.11 to 2.49; P=0.01). Patients homozygous for the risk allele (C) of the -174 G/C polymorphism had higher levels of IL-6 than did those with other genotypes (P=0.04). Homozygous CC patients more frequently had a history of CVD (odds ratio, 2.15; 95% CI, 1.15 to 4.00; P=0.02) as well as a 87% higher rate of incident CV events (hazard ratio, 1.87; 95% CI, 1.02 to 3.44; P=0.04) compared with other genotypes. CONCLUSIONS In patients with stages 2-5 CKD, high serum IL-6 is associated with history of CVD and predicts incident CV events. The parallel relationship with history of CVD and incident CV events of the -174 G/C polymorphism in the IL-6 gene suggests that IL-6 may be causally involved in the high CV risk in this population.
Effect of Joint Center Location on In-Vivo Joint Contact Forces During Walking

Estimation of in-vivo joint contact forces and muscle forces during walking is important in order to protect the knee joint from injury or provide adequate rehabilitation and exercise protocols [1]. Assessment of muscle forces can help to understand the neuro-muscular coordination related on neurological problems [2]. Accurate quantification of joint contact forces can help to characterize the contact phenomena of articular cartilage at the joint related on osteoarthritis and to improve the implant design for the longevity of joint arthroplasty [3]. © 2010 ASME
What Is the Correct Approach for Comparing GFR by Different Methods across Levels of GFR?

Given the centrality of GFR in characterizing CKD, much effort has focused on different ways to determine GFR. The gold standard method is a measured GFR (mGFR) with the clearance of an exogenous ideal marker that is biologically inert and exclusively cleared by glomerular filtration without tubular