bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absence of nebular He ii λ4686 constrains the UV emission from the ultraluminous X-ray pulsar NGC 1313 X-2
Authors: Gúrpide A , Castro Segura N , Soria R , Middleton M 
Published: May 2024

ABSTRACT
While much has been learned in recent decades about the X-ray emission of the extragalactic ultraluminous X-ray sources (ULXs), their radiative output in the ultraviolet (UV) band remains poorly constrained. Understanding of the full ULX spectral energy distribution (SED) is imperative to constrain the accretion flow geometry powering them, as well as their radiative power. Here we present constraints on the UV emission of the pulsating ULX (PULX) NGC 1313 X-2 based on the absence of nebular He ii λ4686 emission in its immediate environment. To this end, we first perform multiband spectroscopy of the ULX to derive three realistic extrapolations of the SED into the inaccessible UV, each predicting varying levels of UV luminosity. We then perform photoionization modelling of the bubble nebula and predict the He ii λ4686 fluxes that should have been observed based on each of the derived SEDs. We then compare these predictions with the derived upper limit on He ii λ4686 from the Multi-Unit Spectroscopic Explorer data, which allows us to infer a UV luminosity LUV ≲ 1 × 1039 erg s−1 in the PULX NGC 1313 X-2. Comparing the UV luminosity inferred with other ULXs, our work suggests there may be an intrinsic difference between hard and soft ULXs, either related to different mass-transfer rates and/or the nature of the accretor. However, a statistical sample of ULXs with inferred UV luminosities is needed to fully determine the distinguishing features between hard and soft ULXs. Finally, we discuss ULXs ionizing role in the context of the nebular He ii λ4686 line observed in star-forming metal-poor galaxies.
Numerical study on the interaction of AGN winds and interstellar medium
Authors: Zhu Yi , Yang Bo , He Guansheng , Jiang Chunhua , Lin Wenbin 
Published: May 2024

ABSTRACT
Accretion disc winds can leave active galactic nuclei (AGNs) and interact with the interstellar medium (ISM) of their host galaxies. We perform two-dimensional numerical simulations to investigate the interaction of AGN winds and ISM. We study the properties of outflows in the 1–1000 pc region under different gravitational potentials and ISM gas densities, and compare these ionized outflows with the observed warm absorbers (WAs). We find that AGN winds drag the ISM and transfer their momentum/energy to the ISM. The properties of winds depend on the gas density of the initial ISM. The higher the initial ISM density, the lower the wind speed, and the narrower the opening angle of the winds. For the case of ρ0 = 10−25 g cm−3, the winds have the strongest intensity at the outer boundary. They can blow the ISM gas, giving feedback on star formation and galaxy evolution. We also find that the interaction of AGN winds and ISM can generate WAs in certain conditions and AGN winds play some roles in generating WAs.
Scattering model of scintillation arcs in pulsar secondary spectra
Authors: Kramer Tobias , Waltner Daniel , Heller Eric J , Stinebring Dan R 
Published: May 2024

ABSTRACT
The dynamic spectra of pulsars frequently exhibit diverse interference patterns, often associated with parabolic arcs in the Fourier-transformed (secondary) spectra. Our approach differs from previous ones in two ways: first, we extend beyond the traditional Fresnel–Kirchhoff method by using the Green’s function of the Helmholtz equation, i.e. we consider spherical waves originating from three-dimensional space, not from a two-dimensional screen. Secondly, the discrete structures observed in the secondary spectrum result from discrete scatterer configurations, namely plasma concentrations in the interstellar medium, and not from the selection of points by the stationary phase approximation. Through advanced numerical techniques, we model both the dynamic and secondary spectra, providing a comprehensive framework that describes all components of the latter spectra in terms of physical quantities. Additionally, we provide a thorough analytical explanation of the secondary spectrum.
#1704 GLP-1RA versus DPP-4 inhibitors and rates of hyperkalemia and discontinuation of renin-angiotensin system (RAS) blockade in Swedish routine care
Authors: Xu Yang , Huang Tao , Bosi Alessandro , Faucon Anne-Laure , Fu Edouard , Carrero Juan-Jesus 
Published: May 2024

Abstract

Background and Aims
Emerging evidence suggest that glucagon-like peptide-1 receptor agonists (GLP-1RA) influence tubular handling of electrolytes and increase potassium excretion, which may translate into reduced risk of hyperkalemia. Hyperkalemia is a common complication that limits persistence on guideline-recommended RAS inhibitors (RASi). Here, we quantified and compared rates of hyperkalemia and RASi discontinuation among users of GLP-1RA versus dipeptidyl peptidase-4 inhibitors (DPP-4i) in a large healthcare system.

Method
We used data from the SCREAM project (Jan 2008-Dec 2021) to conduct a population-based active-comparator, new-user cohort study of adults with type-2 diabetes who started GLP-1RA or DPP-4i. The primary outcome was hyperkalemia occurrence, overall (plasma potassium&gt;5.0 mmol/L) and by severity (mild -potassium &gt;5-≤5.5 mmol/L- and moderate-severe -potassium &gt;5.5 mmol/L- hyperkalemia). Among ongoing RASi users, we assessed time to RASi discontinuation through evaluation of subsequent RASi dispensations. Cox regression with inverse probability of treatment weighting (IPTW) was used to estimate pooled hazard ratios (HRs) and rate differences. Major cardiovascular events (MACEs) served as positive control outcome to evaluate unmeasured confounding bias.

Results
During a median follow-up of 3.0 (Interquartile range [IQR] 1.2-5.6) years, we identified 33 280 eligible participants, of which 13 633 started GLP-1RA and 19 647 DPP-4i. Mean age was 64 years and 40% were women. Compared with DPP-4i, starting GLP-1RA was associated with a lower rate of hyperkalemia (Hazard ratio [HR] 0.91; 95% CI: 0.84-0.99, Fig. 1), with no suggestion of effect modification by baseline eGFR strata (HR 0.91 (0.78-1.07) for eGFR ≥60 and HR 0.92 (0.83-1.01) for eGFR &lt;60 ml/min/1.73 m2, P for interaction &gt;0.05). Similar findings were observed for mild (HR 0.90; 0.83-0.98) and moderate-severe (HR 0.92; 0.80-1.06) hyperkalemia. Out of 21 751 participants that were using RASi, 8 463 discontinued this therapy during median 2.0 (0.7, 4.1) years of follow-up. Initiation of GLP-1RA vs. DPP-4i was associated with lower rate of RASi discontinuation (HR: 0.93; 0.87-0.98), with no interaction across strata of baseline eGFR (HR 0.97 (0.83-1.12) for eGFR ≥60 and HR 0.93 (0.87-0.99) for &lt;60 ml/min/1.73 m2, P for interaction &gt;0.05). Consistent with trial evidence, we observed a lower rate of MACE for GLP-1RA vs DPP-4i (HR 0.87; 0.78-0.98).

Conclusion
In patients with diabetes managed in routine care, the use of GLP-1RA was associated with lower rates of hyperkalemia and discontinuation of RASi compared with DPP-4i, providing further observational evidence in support of the use of these medications.
#1398 Linezolid adsorption during in vitro model of hemoadsorption with mini-module of HA380 cartridge
Authors: Perin Natascha , Lorenzin Anna , de Cal Massimo , Ronco Claudio , Zanella Monica 
Published: May 2024

Abstract

Background and Aims
Septic shock is one of the most frequent causes in Intensive Care Unit (ICU) admission and is related to a very high risk of mortality. About one third of patients with sepsis develops acute kidney injury (AKI) which contributes to a worsening prognosis. AKI due to sepsis is the result of a dysregulated host immune response to infection, with the production of inflammatory mediators and cytokines that cause hemodynamic alterations, endothelial damage, apoptosis and, finally, immunoparalysis. The Jafron HA380 cartridge has been specifically designed for use in clinical conditions characterized by cytokine storm such as sepsis. Given the growing application of these hemoadsorption device in cases of septic AKI in ICU, an unsolved problem is whether these polymers adsorb drugs, including antibiotics. In vitro experiments were conducted to determine its adsorption capacity towards Linezolid (LZD) antibiotic.

Method
In vitro circulation was performed using a dedicated testing platform Galileo. A customized cartridge was built assembling mini-module components scaled in dimension towards HA380 and filled with 75 g of HA380 beads (25% of the regular size cartridge). Peristaltic pump was set at 250 mL/min. Four circulations were performed varying the initial mass of Linezolid in the tested solution (200, 400, 600, 1200 mg). Samples were collected after the first passage (FP) through the cartridge and every 5 or 10 minutes and Linezolid concentrations were measured. Adsorption was assessed considering the Removal Ratio (RR) and its kinetics.

Results
In vitro circulation confirms the affinity of beads material in binding Linezolid molecules. The kinetics shows an instantaneous and rapid adsorption in the very first part of the experiments. After that the adsorption rate decreases due to the decrease of antibiotic available in the solution. Among all the experiments, after the first passage of the solution through the cartridge, a RR higher than 70% has been achieved. After 100 passages of the solution into the cartridge, the adsorption reached about the 100% of RR. None of the amounts of Linezolid tested led to the cartridge saturation. A linear behavior between the mass injected in the solution and the mass adsorbed can be ascribable to the linear phase of Langmuir isotherm (see Fig.).

Conclusion
HA380 adsorbs significant amounts of Linezolid. The linear trend of the isotherm reveals a direct proportionality between binding sites of the sorbent material and the Linezolid tested. Further investigation using a higher quantity of Linezolid is necessary to reach the saturation of the cartridge and to understand the sorbent material capacity. These preliminary results highlight that there is an interaction that could affect the clinical outcome.
#699 Diagnostic accuracy of the Modified Renal Angina Index (mRAI) for predicting acute kidney injury among critically ill Filipino adults
Authors: Alas Karla Patricia , Pasilan Renz Michael 
Published: May 2024

Abstract

Background and Aims
The proposed mRAI (modified renal angina index) (Fig. 1) predicts moderate to severe AKI within the first 7 days of ICU stay which outperforms serum creatinine and urine output. The use of the mRAI in AKI may be warranted to improve predicted performance of AKI biomarkers. The study aims to evaluate the diagnostic accuracy of modified renal angina index in predicting Acute Kidney Injury (AKI) among Critically ill Adult Filipino patient in a Tertiary Institution and its association with in hospital MAKE (Major Adverse Kidney Events).

Method
A retrospective cohort study including all adult critically ill patients, they were dichotomized into “low” (&lt;10) or “high risk” (&gt;10) based on the mRAI score upon the 1st ICU admission (Day 0-24 hr) during the hospital stay. Inclusion criteria: age &gt;18 years old, ICU patients between 2019-2022. Exclusion criteria: Chronic Kidney Disease (Egfr &lt;30 ml/min), Transplant recipients, HIV/Cancer, &lt;48 hrs ICU stay, little changes in creatinine (&lt;2x from baseline between Day 0-24 hr ICU admission). The composite outcome is achieved if at least one is met during the index of hospitalization: All-cause mortality prior to discharge or after ICU admission, New onset of renal replacement therapy (RRT), persistent renal dysfunction.
The sensitivity, specificity, predictive values and area under the curve is used to determine diagnostic accuracy of the mRAI Scoring and its association with in Hospital MAKE. Simple and multiple logistic regression analysis is used to control the effect of confounders in determining the association of mRAI to AKI. SPSS version 20 will be used in the analysis.

Results
Using a cut off score of 10, the mRAI show 84.29% sensitivity, 76.06% specificity, 77.63%, PPV 83.08% NPV 80.14% and AUC 80.14% in predicting moderate to severe AKI (Fig. 2). A mRAI of &gt;10 is associated with in hospital MAKE showing a 97.14% sensitivity, 67.61% specificity, 74.73% PPV, 96.0% NPV, and AUC 82.27% (Fig. 3). Among the high risk group there were 68 (97.1%) who had MAKE, 62 (88.6%) new onset RRT, 12% (17.1%) died within 7 days of ICU admission, 64 (91.4%) persistent renal dysfunction (Fig. 4).

Conclusion
The proposed score can be applied among critically ill adult Filipino patients which is an easy bedside tool for identification of moderate to severe AKI. mRAI constitutes a sensitive test with a high negative predictive, affirming its capability being a screening test, complementary to laboratory parameters and clinical judgement. We also found out that a mRAI score of &gt;10 is associated with In-Hospital Major Adverse Kidney Events.
#2668 New treatments, new challenges: nephrotoxicity associated to naxitamab in patients with high-risk neuroblastoma
Authors: Sancho Pedro Arango , Rodríguez Ana Cristina Aguilar , Espinoza Yarima López , Marín Emma Fortes , Pérez Juan Pablo Muñoz , Obanos Maite Gorostegui , Baños Yolanda Calzada , Báez Víctor Alfonso López , Moreno Marta Jiménez , Sampera Elena Codina , Aris Álvaro Madrid , Mora Jaume 
Published: May 2024

Abstract

Background and Aims
Neuroblastoma is the most common extracranial solid tumor in children, harboring a poor survival for those with high-risk (HR) tumors. Naxitamab (hu3F8) is a humanized monoclonal anti-disialoganglioside (GD2) antibody approved for the treatment of patients older than 1-year with refractory/relapsed HR-neuroblastoma limited to bone and/or bone marrow. First naxitamab (DanyelzaR) infusion was in 2017 in our institution and since then a large experience has been acquired with its use through several clinical trials as well as an expanded named patient access program. The objective is to describe the renal toxicity profile associated to naxitamab in patients with HR-neuroblastoma.

Method
Retrospective descriptive study including 244 patients treated with naxitamab (either on monotherapy or associated to chemotherapy) from June 2017 to December 2022 in whom renal involvement and/or hypertension (HT) was evaluated.

Results
Mean age of the cohort was 8 years (41% female -101- and 59% male -143-), presenting nephrotoxicity of some type up to 26.6% (n = 65): AHT (11.9%), acute renal damage (ARD 10.2%) and proteinuria (5.3%), developing all during the first 3 cycles. All of them were classified as mild adverse events (1-2) according to the Common Terminology Criteria for Adverse Events (CTCAE) scale, except for one patient with ARD grade 3 and two patients with HT grade 3. In the case of HT only in 6 patients an Ambulatory Blood Pressure Monitoring (ABPM) was performed, observing: 2 nocturnal-HT, 2 diurnal-HT without specific-pattern and 2 disautonomic-patterns. Among the ARD, all cases were tubular except for two patients who presented acute tubule-interstitial nephritis (AIN) (one with clinical-analytical pattern and another confirmed by biopsy). Eight of them (32%) had potential confounding factors (previous chemotherapy, ibuprofen or radiotherapy). Among patients with proteinuria (none in the nephrotic range): 38% tubular, 38% glomerular and 23% mixed. Two patients presented ARD + HT and 3 a combination of HT + ARD + proteinuria. All patients received prior chemotherapy and 2 developing chronic renal damage (CKD stage 2 and 3).

Conclusion
Short-and long-term follow-up, the systematic performance of ABPM, and the use of early markers of renal damage, could lead to a more efficient management of complications derived from this new treatment.
#2295 Can we detect the evolution of GFR with estimated GFR in patients with ADPKD?
Authors: Miquel Rosa , Luis-Lima Sergio , Mallén Patricia Isabel Delgado , Torres Sara Estupiñan , Caso Maria Angeles Cobo , Martin Laura Díaz , Rodríguez Silvana , Cruz Coriolano , Rinne Federico González , Hernández Domingo , Porrini Esteban 
Published: May 2024

Abstract

Background and Aims
ADPKD affects about 10% of the patients with CKD. In the disease the formation of cysts replace normal renal parenchyma leading to renal function loss. The evolution of the disease is irregular: some patients lose renal function very fast while others remain stable or have a slow loss. This may have consequences in clinical care. In day-to-day practice, GFR is evaluated by means of formulas, which are algorithms that use creatinine and others markers like age and gender to estimate GFR. However, the accuracy and precision of eGFR in reflecting real GFR in ADPKD is not clear, being this the objective of our study.

Method
To analyse the capacity of eGFR by creatinine-based formulas in predicting mGFR changes over time. We evaluated patients with ADPKD, who underwent mGFR and eGFR by a group 5 equations at baseline, month 6 and then annually. mGFR was evaluated by the clearance of iohexol using dried blood spots (iohexol-DBS) and eGFR with the following creatinine-based equations: Cockcroft-Gault, aMDRD, CKD-EPI, FAS and EKFC. We calculated renal function decline (GFR decline) using repeated measured with mGFR and eGFR. All subjects have at least 3 repeated evaluations of renal function. The agreement between mGFR and eGFR declines was analysed by the concordance correlation coefficient (CCC). Also, we evaluated the capacity of eGFR decline in detecting diverse degree of GFR decline (a) rapid progressors: mGFR of −5 ml/min/y; (b) moderate progressors: −2 to −5 ml/min/y; (c) stable: &gt; −2 ml/min/y.

Results
We evaluated 111 (43; 37% men); age: 42 y ± 14, with a 5 ± 1 evaluations of GFR over time (mGFR and eGFR). The average GFR decline was: −2,8 ml/min/year (mGFR); −3,1 (Cockcroft-Gault), −2,9 (aMDRD), −3,0 (CKD-EPI), −2,8 (FAS) and −2,6 (EFKC) According with mGFR decline, 21 patients (19%) were rapid progressors; 46 (41%) moderate progressors and 44 (40%) stable. The agreement between eGFR decline and mGFR decline was poor, reflected by a low CCC: 0.37 (Cockcroft-Gault); 0.76 (aMDRD); 0.80 (CKD-EPI), 0.77 (FAS); 0.81 (EFKC). In general, eGFR decline failed to detect progression of renal function over time. On average, 43% of the rapid progressors, 53% of the moderate progressors and 54% of the stable patients were not detected by any formula, respectively. Finally, a total of 12% and 6% of those stable or moderate progressors were falsely classified as rapid progressors.

Conclusion
eGFR is not able to reflect properly renal function changes over time in patients with ADPKP in about half of the patients. A relevant number of cases are erroneously considered as rapid progressors or even stable patients. This may have clinical consequences. Whenever possible, mGFR could be considered in this population.
#358 The efficacy and safety of ripertamab (SCT400) in the treatment of primary membranous nephropathy: a single center retrospective study
Authors: Yang Xiao , Tang Bihui 
Published: May 2024

Abstract

Background and Aims
Anti-CD20 monoclonal antibody is gaining increasing clinical acceptance in the treatment of primary membranous nephropathy (PMN). Ripertamab, a novel anti-CD20 monoclonal antibody developed in China, has been shown to be non-inferior to rituximab in efficacy and safety in patients with B-cell non Hodgkin's lymphoma. We aimed to identify the efficacy and safety of ripertamab in PMN retrospectively.

Method
The PMN patients who were diagnosed by renal biopsy and received ripertamab-based therapy between November 1 2022 and June 30 2023 were included. The inclusion criteria were: aged ≥ 18 years, and total B-lymphocyte ratio &lt; 1% after using ripertamab. The exclusion criteria were: follow-up &lt; 6 months, incomplete clinical data, secondary membranous nephropathy due to malignant tumor, systemic lupus erythematosus, hepatitis, etc. The primary outcome was clinical efficacy at 6 months after initial of treatment and secondary outcomes were clinical efficacy at 3 months, safety and the occurrence of adverse events. Complete remission (CR) was defined as urine protein/creatinine ratio (UPCR) &lt; 300 mg/g or 24-hour urinary protein (UP) &lt; 0.3 g, serum albumin &gt;35 g, and stable renal function (eGFR with ≤50% reduction compared with baseline). Partial remission (PR) was defined as UPCR or UP with ≥ 50% reduction compared with baseline, serum albumin &gt;30 g, and stable renal function. No response (NR) was defined as UPCR or UP with &lt; 50% reduction compared with baseline.

Results
A total of 31 patients were included in this retrospective study. The baseline characteristics of the study population and ripertamab treatment responses were described in Table 1. At 6 months, 20 of 31 (64.6%) patients achieved CR (n = 10, 32.3%) or PR (n = 10, 32.3%) after ripertamab treatment (Table 2). Furthermore, 21 of 31 (67.7%) patients who were not given any immunosuppressive therapy before receiving ripertamab achieved CR or PR. Non-responders showed a higher level of proteinuria and a worse renal function at baseline than those of responders. All patients achieved complete B-cell depletion. No adverse events were observed in patients in this study.

Conclusion
Ripertamab can effectively induce remission of PMN and have a favorable safety profile.
#2582 For an efficient CKD healthcare delivery, knock on a door of the orthopaedist!
Authors: Tanaka Hiroshi 
Published: May 2024

Abstract

Background and Aims
CKD patients are usually free from symptoms. Some of them do not wish to visit a physician until the very moment when they suffer from symptoms. Those CKD patients might be found more often in certain medical specialities than others. In order to improve healthcare system efficacy, it is imperative to find the best field we should dig in.

Method
A hospital-wide survey was performed including all the patient visits according to specialities over 365 days in a general hospital. All the laboratory data including eGFR and haemoglobin were retrieved during the period. In case of multiple laboratory measurements in a single patient, a median value was used for analysis. Prevalence of cases with at least one measurement of eGFR during the period was 5 559/11 582 (48.0%) in medicine, 1 195/2 405 (49.7%) in surgery, 691/3 301 (20.9%) in orthopaedics, and 2 808/12 450 (22.5%) in “other” specialities. Here, “other” specialities are highly heterogeneous, including gynecology, dermatology, ophthalmology, otorhinolaryngology, anesthesiology and urology.

Results
A total of 29 738 patients were analyzed. The prevalence of eGFR less than 60 mL/min/1.73 m2 was highest in orthopaedics (353/691, 51.1% among patients with eGFR measurement), much more than those in medicine (2,341/5,559, 42.1%), in surgery (364/1 195, 30.5%) or in others (1 052/2 808, 37.4%). The prevalence of eGFR less than 45 mL/min/1.73 m2 was highest again in orthopaedics (133/691, 19.2%), much more than those in medicine (794/5 559, 14.3%), in surgery (80/1,195, 6.7%) or in others (339/2,808, 12.0%).
The prevalence of renal anemia, defined as eGFR &lt;60 mL/min/1.73 m2 and haemoglobin &lt;11 g/dL, was highest in orthopaedics (74/691, 10.7%), compared with those in medicine (302/5 559, 5.4%), in surgery (35/1 195, 2.9%) or in others (123/2 808, 4.5%).

Conclusion
For an efficient CKD healthcare delivery, the exceedingly high prevalence of CKD among patients visiting orthopaedics should not be missed.