BACKGROUND: Kidney transplantation is a definitive treatment for end-stage renal disease. It is associated with improved life expectancy and quality of life. One of the most common complications following kidney transplantation is graft rejection. To our knowledge, no previous study has identified rejection risk factors in kidney transplant recipients in Saudi Arabia. Therefore, this study aimed to determine the specific risk factors of graft rejection.
METHODS: A multicenter case-control study was conducted at four transplant centers in Saudi Arabia. All adult patients who underwent a renal transplant between January 1, 2015 and December 31, 2021 were screened for eligibility. Included patients were categorized into two groups (cases and control) based on the occurrence of biopsy-proven rejection within 2 years. The primary outcome was to determine the risk factors for rejection within the 2 years of transplant. Exact matching was utilized using a 1:4 ratio based on patients\' age, gender, and transplant year.
RESULTS: Out of 1,320 screened renal transplant recipients, 816 patients were included. The overall prevalence of 2-year rejection was 13.9%. In bivariate analysis, deceased donor status, the presence of donor-specific antibody (DSA), intraoperative hypotension, Pseudomonas aeruginosa, Candida, and any infection within 2 years were linked with an increased risk of 2-year rejection. However, in the logistic regression analysis, the presence of DSA was identified as a significant risk for 2-year rejection (adjusted OR: 2.68; 95% CI: 1.10, 6.49, p = 0.03). Furthermore, blood infection, infected with Pseudomonas aeruginosa or BK virus within 2 years of transplant, were associated with higher odds of 2-year rejection (adjusted OR: 3.10; 95% CI: 1.48, 6.48, p = 0.003, adjusted OR: 3.23; 95% CI: 0.87, 11.97, p = 0.08 and adjusted OR: 2.76; 95% CI: 0.89, 8.48, p = 0.07, respectively).
CONCLUSIONS: Our findings emphasize the need for appropriate prevention and management of infections following kidney transplantation to avoid more serious problems, such as rejection, which could significantly raise the likelihood of allograft failure and probably death. Further studies with larger sample sizes are needed to investigate the impact of serum chloride levels prior to transplant and intraoperative hypotension on the risk of graft rejection and failure.

Inorganic chlorine is susceptible to water and soil salinization due to its non-degradability and high mobility. To clarify the environmental risks associated with the active inorganic chlorine in municipal solid waste (MSW), the specific characteristics and contributions of inorganic chlorine in different MSW categories were investigated in this study. MSW samples were collected from eight representative waste classification residential areas in Hangzhou, China. It was found that the inorganic chlorine content in different MSW categories varied significantly (0-113 mg/g). Perishable waste, paper, and plastic were found to be the main sources of inorganic chlorine in MSW. A four-category classification system was used to quantify the contribution of inorganic chlorine from each waste category. It was found that the misclassification of inorganic chlorine contributions from perishable waste and other waste accounted for 51.96% and 48.04%, respectively. However, when correctly classified into the four-category system, their contributions were reduced to 67.14% and 30.65%, respectively. Therefore, MSW classification showed a significant reduction in the overall contribution of inorganic chlorine. The misclassification reduces the contribution of inorganic chlorine to 48.04%, while correct classification increases the reduction to 69.35%.

BACKGROUND: Haemolysis has been reported as having a positive, negative or no effect on plasma sodium (PNa) and chloride (PCl). We investigated the haemoltytic effect of different haemolysis protocols on PNa and PCl using modelling and laboratory experiments.
METHODS: In a modelling experiment, percentage change and recovery due to dilution in routinely (in vitro) haemolysed samples were compared against shear stress haemolysis and samples spiked with haemolysate from whole blood freeze-thaw, packed cells freeze-thaw and osmotic shock protocols. The results were compared against a control base pool. Additionally, for the osmotic shock method, results were compared against saline- and deionised water (DIW)-spiked controls. In a laboratory experiment, percentage change and recovery were similarly compared using haemolysate from whole blood freeze-thaw and osmotic shock protocols. PNa, PCl and H-index were measured on the Abbott Architect and haemoglobin on the Sysmex XN-9000.
RESULTS: In the modelling experiment, the percentage decrease in PNa and PCl was similar in in vitro haemolysis, shear stress haemolysis, whole blood freeze-thaw haemolysis and packed cells freeze-thaw haemolysis and this was lower compared to the osmotic shock method. In the laboratory experiment, the change in PNa compared to the base pool was less (p < 0.001) per unit increase in H-index in the freeze-thaw method (-0.33 mmol, 95% CI -0.35 to -0.31) compared to the osmotic shock method (-0.65 mmol, 95% CI -0.66 to -0.64). PCl did not change with haemolysis in the freeze-thaw method and changed by -0.21 ± 0.01 mmol per unit increase in the H-index in the osmotic shock method. Recovery of PNa and PCl increased with increasing H-index in both methods.
CONCLUSIONS: The osmotic shock protocol is inappropriate for haemolysis studies because of dilution with DIW used for cell lysis. Recovery calculations may incorrectly compensate for genuine dilution caused by haemolysis.

BACKGROUND: Bromide is a halide ion of the element bromine usually administered in the form of potassium salt as monotherapy or add-on treatment in epileptic dogs. It is excreted unchanged in the urine and undergoes tubular reabsorption in competition with chloride. Thus, dietary chloride content affects serum bromide concentrations. This is the first published clinical report of bromide toxicosis secondary to a dietary modification of chloride content in an epileptic dog treated with potassium bromide.
METHODS: A 3-year-old 55-kg neutered male Tibetan Mastiff was evaluated because of a 1-month history of progressive signs including ataxia, lethargy and behaviour changes. The dog was successfully treated for idiopathic epilepsy since the age of 1-year-old with phenobarbital and potassium bromide. Two months prior to presentation, the owners decided to change the dog\'s diet without veterinary advice. Physical examination was unremarkable. A 12-kg weight gain was recorded since last follow-up (8 months). Neurological examination revealed severe symmetric 4-limbs ataxia with altered vigilance and intermittent episodes of hyperactivity and aggressive behaviour without significant abnormality of cranial nerves. Serum bromide concentration was high and increased by 103 % since last follow-up. Nutritional evaluation revealed a 53 % decrease of chloride content in the diet before and after dietary transition. Bromide toxicosis was suspected, due to bromide reduced clearance secondary to the decreased dietary chloride content. Potassium bromide treatment was lowered by 15 % without further dietary changes. Neurologic signs progressively improved over the next month, without any seizure. After two months, the serum bromide concentration lowered to the same level measured before dietary modification. After four months, neurological examination was unremarkable.
CONCLUSIONS: Dietary chloride content can directly influence serum bromide concentrations, therefore affecting seizure control or contributing to unexpected adverse effects. In the present case, a reduction in chloride intake markedly increased serum bromide concentrations causing bromism. Dietary changes should be avoided in dogs treated with potassium bromide to maintain stable serum bromide levels.

Emergency department presentations of sodium nitrate poisoning are increasing in frequency. Point-of-care blood gas analysis is useful for identifying methaemoglobinaemia and other abnormalities in such patients. Topically applied nitrate is known to positively interfere with chloride measurement in both point-of-care instruments and automated analysers of the clinical chemistry laboratory. In this article, the authors describe a case of pseudohyperchloraemia caused by sodium nitrate, which was consumed orally for the purpose of suicide. Consistent with the established pattern of interference, the ABL800 (Radiometer Medical, Brønshøj Copenhagen) blood gas analyser produced spuriously high chloride results, whilst the Alinity (Abbott Diagnostics, Abbot Park, Illinois) automated analyser resulted in chloride measurements comparable to those of inductively coupled mass spectrometry (ICP-MS). Both instruments, measure chloride with ion-selective electrodes (ISEs). The ABL800 (Radiometer) uses a membrane electrode, which is vulnerable to permeation by lipophilic nitrate ions, whereas the Alinity (Abbott) employs a silver chloride redox electrode system that is resistant to precipitation of silver nitrate due to its relatively high solubility. These mechanistic differences likely explain why nitrate interferes with some point-of-care devices but does not appear to affect the results of automated analysers.

The resulting solutions from the cotton fabrics dyeing using the trichromy Procion HEXL, with NaCl as electrolyte, were electrochemically treated. These dyes have two azo groups as chromophores and two monochlorotriazinic groups as reactive groups in their structure. The combined oxidation/reduction at 125 mA cm-2 in a filter-press cell without compartment separation was carried out using an anode of Ti/SnO2-Sb-Pt and a cathode of stainless steel. This procedure has been effective in previous experiments using sulphate as electrolyte. A significant decrease in total organic carbon (TOC), chemical oxygen demand (COD), and total nitrogen (TN) was obtained. Moreover, the process took place efficiently. The average oxidation state (AOS) and the carbon oxidation state (COS) data confirmed the presence of stable oxidized intermediates in the electrolysed solution. The chromatography and the UV-Visible spectrophotometry assays indicated that full decolourisation is obtained at a loaded charge of around 0.81 Ah L-1 which is associated with an electrical energy per order (EEO) of 1.20 kWh m-3.

The activity of Na+-K+ ATPase is altered in sickle cell disease (SCD), which affects serum electrolyte levels. This alteration is associated with several complications in sickle cell patients. This study evaluated the serum levels of sodium, potassium, and chloride in patients with SCD. The study was a case-control cross-sectional study involving 120 SCD patients in the steady state and 48 \'healthy\' controls. The SCD patients were made up of 69 HbSS patients and 41 HbSC patients. Serum electrolyte levels (Na+, K+, and Cl-) were measured using a Flame Atomic Absorption Spectrometer (Variant 240FS; Varian Australia Pty Ltd). Serum sodium levels were significantly lower in the sickle cell patients, compared with their \'healthy\' counterparts (P = .0001). Although the study found significantly higher serum levels of potassium in the SCD patients (P = .0001), there was no significant difference in serum chloride levels between patients with SCD and the controls (P = .098). Serum sodium and chloride levels were not significantly different in both HbSS and HbSC patients (P = .197 and P = .553, respectively). The level of serum potassium in the HbSS patients was, however, significantly higher compared with those with the HbSC genotype (P = .0001). There is higher efflux of K+ from the intracellular into the extracellular space in HbSS patients, which may lead to red cell membrane dysfunction and associated complications.

Compared with conventional diuretic therapy, monitoring decompensated heart failure (HF) under treatment with a vasopressin antagonist is problematic because (1) use of this medication usually allows the patient free water intake to prevent drug-induced hypernatremia and (2) this medication often induces only minimal changes in the hemodynamics and blood concentration. In a 68-year-old female HF patient, use of tolvaptan did not induce much change in the urine output, presumably because of the low water intake due to a lack of thirst, but she did achieve a profound weight loss. Both the changes in chloride and sodium were negatively correlated with changes in the hemoglobin and serum creatinine, and positively correlated with changes in the mean red blood cell volume, but changes in the serum chloride were better correlated with each variable than were changes in the serum sodium. case of heat failure therapy using a vasopressin antagonist highlights the importance of monitoring serum chloride concentration in relation to changes in the hemoglobin (to evaluate intravascular volume) and mean red cell volume (to estimate intracellular fluid status) in addition to changes in body weight.>.

A total of 14 samples were collected in May 2016(dry season)and August 2016 (wet season) in the downstream area of the Taizi River. △15 N-NO3- and △18 O-NO3- were determined using the azide method, and △18 O-H2O was determined using a CO2-H2O equilibration technique. To identify NO3- sources and transformations in the downstream area of Taizi River Basin, ion chromatography, Nessler\'s reagent spectrophotometry, the azide method, and CO2-H2O equilibration methods were utilized to determine the concentrations of NO3-, Cl-, NH4+-N, and isotopic compositions (△15 N and △18 O) of NO3- and the △18 O-H2O in surface water. The results showed that the NO3- was mainly derived from mixed sources. During the dry season, the nitrate in the surface water was derived from soil nitrogen, manure, and sewage in the upper reaches, and mainly derived from synthetic fertilizer, manure, and sewage in the middle and lower reaches of the Beisha River. The nitrate was mainly derived from manure and sewage in the Nansha River. The nitrate was mainly derived from soil nitrogen in the upper reaches, mainly derived from synthetic fertilizer, manure, and sewage in the middle reaches, and mainly derived from manure and sewage in the lower reaches of the Haicheng River. During the wet season, the nitrate sources in surface water were soil nitrogen, synthetic fertilizer, manure, and sewage in the Beisha River; synthetic fertilizer, manure, and sewage in the middle and lower reaches of the Haicheng River and the Nansha River; and soil nitrogen and synthetic fertilizer in the upper reaches of the Haicheng River. NO3- and NH4+-N concentrations decreased with increasing △15 N-NO3- from the dry season to the wet season, indicating that volatilization of NH4+-N and denitrification of NO3- might occur during the wet season. There is a slightly positive relationship between the reciprocal of the concentration of 1/ρ(NO3-) and △15 N-NO3- during the wet season, indicating that mixing processes occurred in surface water. The results will provide information on nitrate sources during seasonal variations in the plain areas.

This study analyzed the nitrate (NO3-), ammonia nitrogen (NH4+-N), chloride (Cl-), δ15 N-NO3-, δ18O-NO3-, and δ18O-H2O in the surface water to identify the nitrate sources and transformation processes in midstream areas of the Taizi River basin in May and August 2016, corresponding to the dry season and wet season, respectively. The results indicated that the NO3-, Cl-, and NH4+-N concentrations and the δ18O-NO3- in the dry season were greater than those in the wet season, and the δ15 N-NO3- did not show significant seasonal variations based on the Man-Whitney U test. The NO3- was derived mainly from the mixed sources according to the ranges of NO3-/Cl-, δ15 N-NO3-, and δ18O-NO3-. The nitrate sources in the surface water were synthetic fertilizer, soil nitrogen, manure, and sewage in the Xihe River (XR), Lanhe River (LR), and Xiada River (XDR) and soil nitrogen and synthetic fertilizer in the Er dao River (EDR) during the wet season. The sources were synthetic fertilizer and soil nitrogen in the XDR and soil nitrogen, manure, and sewage in the XR, LR, and EDR during the dry season. The significant negative relationship between NO3- and NH4+ and the significant positive relationship between NO3- and δ15 N-NO3- in the wet season indicated that the volatilization and nitrification of soil N might be related to NO3- sources in the wet season. NH4+-N and δ15 N-NO3- increased with decreasing NO3- and Cl- in EDR and LR during the wet season, which indicated denitrification processes occurred. There was a significant relationship between NO3- and Cl-, indicating that mixing processes occurred in the surface water during the two sampling periods. This study will provide a better understanding for nitrate sources related to seasonal variations and transformation processes in hilly areas.