Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites

AIM： To evaluate the accuracy of spot urinary Na/K and Na/creatinine （Cr） ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS： The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/ Cr ratio and 24-h urinary sodium. Student＇s t test was used to compare the interval variables and x^2 test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS： The best cutoff point for Na/K ratio was 2.5 （P 〈 0.001） and area under the curve （AUC） was 0.9, and for Na/Cr ratio, the best cutoff point was 35 （P 〈 0.001） and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio （87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively）. CONCLUSION： Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites.

24-Hour Urinary Sodium Excretion Association with Cardiovascular Events:A Systematic Review and Dose-Response Meta-Analysis

Objective The relationship between sodium intake and cardiovascular(CV)events remains unconfirmed.Therefore,we carried out a systematic review and dose-response meta-analysis for evaluating the potential impact of 24-hour sodium excretion on CV risk.Besides,24-hour sodium excretion was used to replace daily sodium diet intake.Methods We searched ISI Web of Science,Embase,Pub Med,and the Cochrane Library.Our study included cohort studies reporting hazard ratio(HR).The random-effects model was used for summarizing the total relative risks(RRs)between the included studies.In addition,the generalized least-squares regression was employed to fit the study model.Results A total of 9 studies involving 645,006 participants were included in this study.A significant non-linear relationship was observed between sodium excretion and CV events(P^(non-linearity)<0.001).In studies collecting 24-h urine samples,the sodium excretion and CV events risk were associated linearly(RR:1.04;95%CI:1.01,1.07).Conclusion In a linear dose-response manner,every 1 g increase in sodium intake was associated with an increased risk of CV events up to 4%.Further studies are required to validate our conclusions further.

Association of a Tobacco-specific Nitrosamine Carcinogen with Urinary Cotinine,Urinary Sodium Excretion,and Total Energy Intake in Adolescents and Children

This study investigated the association of a tobacco-specific nitrosamine carcinogen,4-(methylnitrosamino)-1-(3-pyridy1)-I-butanol(NNAL)with urinary cotinine(uCot),urinary sodium(uNa)excretion,systolic blood pressure(sBP),and total energy intake in adolescents and children in relation to the subjects'age.A total of 790 subjects aged 6-19 years were evaluated.NNAL,uCot,corrected NNAL(cNNAL),the NNAL/uCot ratio,uNa,sBP,and nutrient intake were measured.A strong association between uCot and cNNAL was observed in children who were 11 years of age(r=0.881,P<0.001);however,no significant association was noted in adolescents who were 19 years of age.The uNa level was significantly higher(133.9 mmol/L vs.107.8 mmol/L,P<0.001)and sBP was significantly lower(105.3 mmHg vs.110.6 mmHg,P=0.012)in adolescents with elevated NNAL than in those without elevated NNAL.NNAL was significantly higher in subjects with increased uNa excretion than in those without increased uNa excretion.NNAL was positively correlated with uNa(r=0.183,P<0.001)and negatively correlated with sBP(r=0.142,P<0.001).Non-smokers with elevated NNAL/uCot ratios had significantly lower total energy intake than those without elevated NNAL/uCot ratios(1729.0 kcal/day vs.1911.0 kcal/day,P=0.008).The relationship between NNAL and uCot varied according to the subjects'age.NNAL seems to play a role in decreasing sBP by enhancing uNa excretion.Insufficient nutrient intake may contribute to endogenous formation of NNAL in non-smoking adolescents and children.

Cosinor-rhythmometry for 24-h urinary sodium,potassium,creatinine excretion in the Chinese adult population

Background:The low accuracy of equations predicting 24-h urinary sodium excretion using a single spot urine sample contributed to the misclassification of individual sodium intake levels.The application of single spot urine sample is limited by a lack of representativity of urinary sodium excretion,possibly due to the circadian rhythm in urinary excretion.This study aimed to explore the circadian rhythm,characteristics,and parameters in a healthy young adult Chinese population as a theoretical foundation for developing new approaches.Methods:Eighty-five participants(mean age 32.4 years)completed the 24-h urine ollction by sccessively cllecing each of the single-voided specimens within 24 h.The concentrations of the urinary sodium,potassium,and creatinine for cach voided specimen were measured.Cosinor analysis was applied to explore the circadian rhythm of the urinary sodium,potassium,and creatinine excretion.The excretion per hour was computed for analyzing the change over time with repeated-measures analysis of variance and a cubic spline model.Results:The metabolism of urinary sodium,potassium,and creatinine showed different patterns of circadian rhythm,although the urinary sodiurm excretion showed non-significant parameters in the cosinor model.A significant circadian rhythm of urinary creatinine excretion was observed,while the circadian rhythm of sodium was less significant than that of potassium.The circadian rhythm of urinary sodium and creatinine excretion showed synchronization to some extent,which had a nocturnal peak and fell to the lowest around noon to afternoon.In contrast,the peak of potassium was observed in the morning and dropped to the lowest point in the evening.The hourly urinary excretion followed a similar circadian rhythm.Conclusion:It is necessary to consider the circadian rhythm of urinary sodium,potassium,and creatinine excretion in adults while exploring the estimation model for 24-h urinary sodium excretion using spot urine.

Fractional excretion of sodium in hepatorenal syndrome:Clinical and pathological correlation

AIMTo determine the accuracy of fractional excretion of sodium (FeNa) in the diagnosis of hepatorenal syndrome (HRS). METHODSEighty-eight liver transplantation candidates with renal dysfunction and/or proteinuria were included in the study sample. The baseline characteristics of the patients were obtained. All the 88 patients underwent iothalamate glomerular filtration rate testing, 24-h urine collection for urinary sodium and protein excretions, random urine for sodium and creatinine testing, and percutaneous kidney biopsy. FeNa was calculated using the equation [(urine sodium &times; serum creatinine)/(serum sodium &times; urine creatinine)] &times; 100%. Diuretic use was recorded among the participants. Patients on renal replacement therapy were not included in the original sample. RESULTSSeventy-seven (87%) of the 88 patients had FeNa P = 0.4). FeNa P = 0.47). Calculated positive predictive value and negative predictive value for FeNa P = 0.41). CONCLUSIONFeNa 1%.

A Participant-assigned Interventional Research of Precesarean Internal Iliac Artery Balloon Catheterization for Managing Intraoperative Hemorrhage of Placenta Previa and Placenta Accreta Spectrum Disorders After Cesarean Section

Placenta accreta spectrum disorder (PASD) and placenta previa (PP) are two of the mosthideous obstetric complications which are usually associated with a history of cesarean section(CS). Moreover, women with PASD, PP and/or a cesarean scarred uterus are more likely to haveadverse pregnancy outcomes, including blood transfusion, hysterectomy, pelvic organs damage,postpartum hemorhage, disseminated intravascular coagulation, multi-organ dysfunction syndromeand even maternal or fetal death. This study aimed to investigate the efficacy of precesareaninternal iliac artery balloon catheterization (BC) for managing severe hemorhage caused by PASDand PP with a history of CS. This participant-assigned interventional study was conducted inTongji Hospital. We recruited 128 women with suspected PASD, PP and a history of CS. Womenin the BC group accepted precesarean BC of bilateral internal iliac arteries before the scheduledcesarean delivery. Women in the control group underwent a conventional cesarean delivery.Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complicationsand neonatal outcomes were discussed. There were significant differences in calculated bloodloss (CBL) between BC group and control group (1015.0±144.9 vs. 1467.0±171.0 mL, P=0.04).Precesarean BC could reduce intraoperative red blood cell (RBC) transfusion as compared withcontrol group (799.5±136.1 vs. 1286.0±161.6 mL, P=0.02) and lessen the rate of using bloodproducts (57.1% vs. 76.4%, P=0.02). The incidence of hysterectomy was also lower in BC groupthan in control group. Postpartum outcomes showed no significant differences between the twogroups, except that postoperation hospitalization was longer in BC group than in control group(6.7±0.4 vs. 5.8±0.2 days, P=0.03). Precesarean BC of internal iliac artery is an effective methodfor managing severe hemorrhage caused by PASD and PP with a cesarean scarred uterus, as it couldreduce intraoperative blood loss, lessen intraoperative RBC transfusions and potentially decreasehysterectomies.

Daily Intake of a Commercially Available Vegetable Juice Has Beneficial Effects on Metabolic Syndrome-Related Biomarkers in Young, Healthy Japanese Adults

Adequate vegetable intake is important in reducing the risk of lifestyle-related diseases;however, intake amongst young Japanese adults is poor. This study aimed to assess the effect of daily intake of a commercially available vegetable juice on nutritional status and metabolic syndrome-related markers in healthy young adults. Fifty-one healthy adults (14 men, 37 women), age 20 - 22 years were recruited, and their food and nutritional intake was surveyed using an FFQ based on Food Groups. Subjects were divided into either a control group, who were not administered vegetable juice, or an intervention group, who consumed 200 mL vegetable juice daily for 2 months. Anthropometric data, serum carotenoid concentrations, blood and urinary parameters were measured at baseline and at 2 months. The average intake of vegetables in all subjects at baseline was approximately 140 g/day, less than half the dose recommended by the Japanese government. Total serum carotenoid concentration in the intervention group doubled from baseline after 2 months. In particular, serum concentrations of α-carotene, β-carotene, and lycopene were increased. In the intervention group, 24-hour urinary potassium excretion increased significantly, and 24-hour urinary sodium to potassium ratio decreased significantly. Waist circumference and systolic blood pressure also decreased significantly. Daily intake of a commercial vegetable juice for 2 months improved nutritional status in young adults with inadequate vegetable intake, shown by improved serum carotenoid and urine potassium levels. In addition, intake of vegetable juice may be beneficial in reducing the risk of metabolic syndrome.

Examination of in vivo mutagenicity of sodium arsenite and dimethylarsinic acid in gpt delta rats

Arsenic is a well-known human bladder and liver carcinogen, but its exact mechanism of carcinogenicity is not fully understood. Dimethylarsinic acid（DMAV） is a major urinary metabolite of sodium arsenite（i As~Ⅲ） and induces urinary bladder cancers in rats. DMAVand i As~Ⅲare negative in in vitro mutagenicity tests. However, their in vivo mutagenicities have not been determined. The purpose of present study is to evaluate the in vivo mutagenicities of DMAVand i As~Ⅲin rat urinary bladder epithelium and liver using gpt delta F344 rats.Ten-week old male gpt delta F344 rats were randomized into 3 groups and administered 0,92 mg/L DMAV, or 87 mg/L i As~Ⅲ（each 50 mg/L As） for 13 weeks in the drinking water. In the mutation assay, point mutations are detected in the gpt gene by 6-thioguanine selection（gpt assay） and deletion mutations are identified in the red/gam genes by Spi-selection（Spi-assay）. Results of the gpt and Spi-assays showed that DMAVand i As~Ⅲhad no effects on the mutant frequencies or mutation spectrum in urinary bladder epithelium or liver. These findings indicate that DMAVand i As~Ⅲare not mutagenic in urinary bladder epithelium or liver in rats.