Glomerular filtration rate (GFR) estimates facilitate detection of chronic kidney disease but require calibration of the serum creatinine assay to the laboratory that developed the equation. The ...4-variable equation from the Modification of Diet in Renal Disease (MDRD) Study has been reexpressed for use with a standardized assay.
To describe the performance of the revised 4-variable MDRD Study equation and compare it with the performance of the 6-variable MDRD Study and Cockcroft-Gault equations.
Comparison of estimated and measured GFR.
15 clinical centers participating in a randomized, controlled trial.
1628 patients with chronic kidney disease participating in the MDRD Study.
Serum creatinine levels were calibrated to an assay traceable to isotope-dilution mass spectrometry. Glomerular filtration rate was measured as urinary clearance of 125I-iothalamate.
Mean measured GFR was 39.8 mL/min per 1.73 m2 (SD, 21.2). Accuracy and precision of the revised 4-variable equation were similar to those of the original 6-variable equation and better than in the Cockcroft-Gault equation, even when the latter was corrected for bias, with 90%, 91%, 60%, and 83% of estimates within 30% of measured GFR, respectively. Differences between measured and estimated GFR were greater for all equations when the estimated GFR was 60 mL/min per 1.73 m2 or greater.
The MDRD Study included few patients with a GFR greater than 90 mL/min per 1.73 m2. Equations were not compared in a separate study sample.
The 4-variable MDRD Study equation provides reasonably accurate GFR estimates in patients with chronic kidney disease and a measured GFR of less than 90 mL/min per 1.73 m2. By using the reexpressed MDRD Study equation with the standardized serum creatinine assay, clinical laboratories can report more accurate GFR estimates.
Immune checkpoint molecules, including inhibitory and stimulatory immune checkpoint molecules, are defined as ligand-receptor pairs that exert inhibitory or stimulatory effects on immune responses. ...Most of the immune checkpoint molecules that have been described so far are expressed on cells of the adaptive immune system, particularly on T cells, and of the innate immune system. They are crucial for maintaining the self-tolerance and modulating the length and magnitude of immune responses of effectors in different tissues to minimize the tissue damage. More and more evidences have shown that inhibitory or stimulatory immune checkpoint molecules are expressed on a sizeable fraction of tumor types. Although the main function of tumor cell-associated immune checkpoint molecules is considered to mediate the immune evasion, it has been reported that the immune checkpoint molecules expressed on tumor cells also play important roles in the maintenance of many malignant behaviors, including self-renewal, epithelial-mesenchymal transition, metastasis, drug resistance, anti-apoptosis, angiogenesis, or enhanced energy metabolisms. In this section, we mainly focus on delineating the roles of the tumor cell-associated immune checkpoint molecules beyond immune evasion, such as PD-L1, PD-1, B7-H3, B7-H4, LILRB1, LILRB2, TIM3, CD47, CD137, and CD70.
Cystatin C is an endogenous glomerular filtration marker hence its serum level is affected by the glomerular filtration rate (GFR). To study what other factors might affect it blood level we ...performed a cross-sectional analysis of 3418 patients which included a pooled dataset of clinical trial participants and a clinical population with chronic kidney disease. The serum cystatin C and creatinine levels were related to clinical and biochemical parameters and errors-in-variables models were used to account for errors in GFR measurements. The GFR was measured as the urinary clearance of 125I-iothalamate and 51Cr-EDTA. Cystatin C was determined at a single laboratory while creatinine was standardized to reference methods and these were 2.1+/-1.1 mg/dL and 1.8+/-0.8 mg/L, respectively. After adjustment for GFR, cystatin C was 4.3% lower for every 20 years of age, 9.2% lower for female gender but only 1.9% lower in blacks. Diabetes was associated with 8.5% higher levels of cystatin C and 3.9% lower levels of creatinine. Higher C-reactive protein and white blood cell count and lower serum albumin were associated with higher levels of cystatin C and lower levels of creatinine. Adjustment for age, gender and race had a greater effect on the association of factors with creatinine than cystatin C. Hence, we found that cystatin C is affected by factors other than GFR which should be considered when the GFR is estimated using serum levels of cystatin C.
Equations to estimate glomerular filtration rate (GFR) are routinely used to assess kidney function. Current equations have limited precision and systematically underestimate measured GFR at higher ...values.
To develop a new estimating equation for GFR: the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Cross-sectional analysis with separate pooled data sets for equation development and validation and a representative sample of the U.S. population for prevalence estimates.
Research studies and clinical populations ("studies") with measured GFR and NHANES (National Health and Nutrition Examination Survey), 1999 to 2006.
8254 participants in 10 studies (equation development data set) and 3896 participants in 16 studies (validation data set). Prevalence estimates were based on 16,032 participants in NHANES.
GFR, measured as the clearance of exogenous filtration markers (iothalamate in the development data set; iothalamate and other markers in the validation data set), and linear regression to estimate the logarithm of measured GFR from standardized creatinine levels, sex, race, and age.
In the validation data set, the CKD-EPI equation performed better than the Modification of Diet in Renal Disease Study equation, especially at higher GFR (P < 0.001 for all subsequent comparisons), with less bias (median difference between measured and estimated GFR, 2.5 vs. 5.5 mL/min per 1.73 m(2)), improved precision (interquartile range IQR of the differences, 16.6 vs. 18.3 mL/min per 1.73 m(2)), and greater accuracy (percentage of estimated GFR within 30% of measured GFR, 84.1% vs. 80.6%). In NHANES, the median estimated GFR was 94.5 mL/min per 1.73 m(2) (IQR, 79.7 to 108.1) vs. 85.0 (IQR, 72.9 to 98.5) mL/min per 1.73 m(2), and the prevalence of chronic kidney disease was 11.5% (95% CI, 10.6% to 12.4%) versus 13.1% (CI, 12.1% to 14.0%).
The sample contained a limited number of elderly people and racial and ethnic minorities with measured GFR.
The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
National Institute of Diabetes and Digestive and Kidney Diseases.
An equation from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) provides more accurate estimates of the glomerular filtration rate (eGFR) than that from the modification of diet in ...renal disease (MDRD) Study, although both include a two-level variable for race (Black and White and other). Since creatinine generation differs among ethnic groups, it is possible that a multilevel ethnic variable would allow more accurate estimates across all groups. To evaluate this, we developed an equation to calculate eGFR that includes a four-level race variable (Black, Asian, Native American and Hispanic, and White and other) using a database of 8254 patients pooled from 10 studies. This equation was then validated in 4014 patients using 17 additional studies from the United States and Europe (validation database), and in 1022 patients from China (675), Japan (248), and South Africa (99). Coefficients for the Black, Asian, and Native American and Hispanic groups resulted in 15, 5, and 1% higher levels of eGFR, respectively, compared with the White and other group. In the validation database, the two-level race equation had minimal bias in Black, Native American and Hispanic, and White and other cohorts. The four-level ethnicity equation significantly improved bias in Asians of the validation data set and in Chinese. Both equations had a large bias in Japanese and South African patients. Thus, heterogeneity in performance among the ethnic and geographic groups precludes use of the four-level race equation. The CKD-EPI two-level race equation can be used in the United States and Europe across a wide range of ethnicity.
Large-scale applications of rechargeable batteries consume nonrenewable resources and produce massive amounts of end-of-life wastes, which raise sustainability concerns in terms of manufacturing, ...environmental, and ecological costs. Therefore, the recyclability and sustainability of a battery should be considered at the design stage by using naturally abundant resources and recyclable battery technology. Herein, we design a fully recyclable rechargeable sodium ion battery with bipolar electrode structure using Na
V
(PO
)
as an electrode material and aluminum foil as the shared current collector. Such a design allows exceptional sodium ion battery performance in terms of high-power correspondence and long-term stability and enables the recycling of ∼100% Na
V
(PO
)
and ∼99.1% elemental aluminum without the release of toxic wastes, resulting in a solid-component recycling efficiency of >98.0%. The successful incorporation of sustainability into battery design suggests that closed-loop recycling and the reutilization of battery materials can be achieved in next-generation energy storage technologies.
Glomerular filtration rate (GFR) estimates facilitate detection of chronic kidney disease. Performance of the Modification of Diet in Renal Disease (MDRD) Study equation varies substantially among ...populations. To describe the performance of the equation in a large, diverse population, estimated GFR (eGFR) was compared to measured GFR (mGFR) in a cross-sectional analysis of 5504 participants in 10 studies that included measurements of standardized serum creatinine and urinary clearance of iothalamate. At eGFR <60 ml/min per 1.73 m(2), the MDRD Study equation had lower bias and higher precision than at eGFR > or =60 ml/min per 1.73 m(2). The accuracy of the equation, measured by the percent of estimates that fell within 30% of mGFR, was similar for eGFR values above or below 60 ml/min per 1.73 m(2) (82% and 84%, respectively). Differences in performance among subgroups defined by age, sex, race, diabetes, transplant status, and body mass index were small when eGFR was <60 ml/min per 1.73 m(2). The MDRD Study equation therefore provides unbiased and reasonably accurate estimates across a wide range of subgroups when eGFR is <60 ml/min per 1.73 m(2). In individual patients, interpretation of GFR estimates near 60 ml/min per 1.73 m(2) should be interpreted with caution to avoid misclassification of chronic kidney disease in the context of the clinical setting.
•The combination of MNDWI and NDVI is the best indicator of LST than others.•Both UHI intensity and UHI strength index may be closely related to the surface water content.•The regions that UHI ...intensity index is greater than 0.5 can be considered as key areas of UHI elimination.
To explore impacts of urban surface characteristics on spatiotemporal pattern of land surface temperature (LST), LST was retrieved from the thermal infrared band of satellite images and five indices were selected and extracted from remote sensing images in different time periods respectively acquired from 1992 to 2014. The correlation analysis (pixel by pixel) and linear regression analysis showed that although Normalized Difference Built-up Index (NDBI) and LST had the highest correlation coefficient, a combination of Modified Normalized Difference Water Index (MNDWI) and Normalized Difference Vegetation Index (NDVI) yielded the best regression results (the mean of R-squared value increased 0.1). These results showed that both NDBI and NDVI-MNDWI would be acceptable indicators of LST, but NDVI-MNDWI could be better. Moreover, urban heat island (UHI) intensity (represented by LST) analysis showed that the highest UHI intensity appeared in the April, while the lowest UHI intensity index emerged in June. These results suggested that both UHI intensity and UHI intensity index might be closely related to land surface moisture. Furthermore, the regions of UHI intensity index greater than 0.5 were unchanged essentially from 2000 to 2014. So, these regions would be considered as key areas where the UHI could be focused on elimination.
Metal-organic framework (MOF)-derived nanomaterials have attracted widespread attention, because the excellent features, such as high surface area, porosity and tunable properties are inherited from ...MOFs. Moreover, the derivatives avoid the poor conductivity and stability of MOFs. MOF-derived nanomaterials can easily be regulated by a specific selection of metal nodes and organic linkers, resulting in multifunctionality in photocatalysis. MOF derivatives can be used not only as semiconductor photocatalysts, but also as co-catalysts for photocatalytic hydrogen evolution, CO2 reduction, pollutants degradation, etc. This review focuses on the multifunctional applications of MOF derivatives in the field of photocatalysis. The researches in recent years are analyzed and summarized from the aspects of preparation, modification and application of MOF derivatives. At the end of the review, the development and challenges of MOF derivatives applied in photocatalysis in the future are put forward, in order to provide more references for further research in this field and bring new inspiration.
MOF derivatives, which inherit the multiple advantages of MOF materials, and avoid the disadvantages of poor conductivity and stability, exhibit great application potential in the field of photocatalysis not only as semiconductor photocatalysts but also as cocatalysts.
To address the problem of low recall rate in the detection of prohibited items in X-ray images due to the severe object occlusion and complex background, an X-ray prohibited item detection network, ...ScanGuard-YOLO, based on the YOLOv5 architecture, is proposed to effectively improve the model's recall rate and the comprehensive metric F1 score. Firstly, the RFB-s module was added to the end part of the backbone, and dilated convolution was used to increase the receptive field of the backbone network to better capture global features. In the neck section, the efficient RepGFPN module was employed to fuse multiscale information from the backbone output. This aimed to capture details and contextual information at various scales, thereby enhancing the model's understanding and representation capability of the object. Secondly, a novel detection head was introduced to unify scale-awareness, spatial-awareness, and task-awareness altogether, which significantly improved the representation ability of the object detection heads. Finally, the bounding box regression loss function was defined as the WIOUv3 loss, effectively balancing the contribution of low-quality and high-quality samples to the loss. ScanGuard-YOLO was tested on OPIXray and HiXray datasets, showing significant improvements compared to the baseline model. The mean average precision (mAP@0.5) increased by 2.3% and 1.6%, the recall rate improved by 4.5% and 2%, and the F1 score increased by 2.3% and 1%, respectively. The experimental results demonstrate that ScanGuard-YOLO effectively enhances the detection capability of prohibited items in complex backgrounds and exhibits broad prospects for application.
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