Background: In patients with chronic kidney disease (CKD), atrial fibrillation (AF) is highly prevalent and represents a major risk factor for stroke and death. CKD is associated with atrial proarrhythmic remodeling and activation of the sympathetic nervous system. Whether reduction of the sympathetic nerve activity by renal denervation (RDN) inhibits AF vulnerability in CKD is unknown. Methods: Left atrial (LA) fibrosis was analyzed in samples from patients with AF and concomitant CKD (estimated GFR, <60 mL/min per 1.73 m 2 ) using picrosirius red and compared with AF patients without CKD and patients with sinus rhythm with and without CKD. In a translational approach, male Sprague Dawley rats were fed with 0.25% adenine (AD)-containing chow for 16 weeks to induce CKD. At week 5, AD-fed rats underwent RDN or sham operation (AD). Rats on normal chow served as control. After 16 weeks, cardiac function and AF susceptibility were assessed by echocardiography, radiotelemetry, electrophysiological mapping, and burst stimulation, respectively. LA tissue was histologically analyzed for sympathetic innervation using tyrosine hydroxylase staining, and LA fibrosis was determined using picrosirius red. Results: Sirius red staining demonstrated significantly increased LA fibrosis in patients with AF+CKD compared with AF without CKD or sinus rhythm. In rats, AD demonstrated LA structural changes with enhanced sympathetic innervation compared with control. In AD, LA enlargement was associated with prolonged duration of induced AF episodes, impaired LA conduction latency, and increased absolute conduction inhomogeneity. RDN treatment improved LA remodeling and reduced LA diameter compared with sham-operated AD. Furthermore, RDN decreased AF susceptibility and ameliorated LA conduction latency and absolute conduction inhomogeneity, independent of blood pressure reduction and renal function. Conclusions: In an experimental rat model of CKD, RDN inhibited progression of atrial structural and electrophysiological remodeling. Therefore, RDN represents a potential therapeutic tool to reduce the risk of AF in CKD, independent of changes in renal function and blood pressure.

Background: Renal denervation (RDN) lowers blood pressure (BP) in patients with uncontrolled hypertension. Limited data exist on the effectiveness of different antihypertensive medications following RDN on BP and maladaptive cardiac phenotypes. Methods: Eighty-nine male spontaneously hypertensive rats with continuous BP recording underwent RDN or sham operation. Ten days postsurgery, spontaneously hypertensive rats were randomized to receive no antihypertensive medication, amlodipine, olmesartan, hydrochlorothiazide, bisoprolol, doxazosin, or moxonidine for 28 days. Cardiac remodeling was determined histologically, and activation of the renin-angiotensin-aldosterone system was explored. Results: Before initiation of antihypertensive drugs, RDN reduced mean arterial pressure (−12.6 mm Hg [95% CI, −14.4 to −10.8]; P <0.001). At study end, mean arterial pressure was lower in RDN compared with sham operation in drug-naïve controls ( P =0.006), olmesartan ( P =0.002), amlodipine ( P =0.0004), hydrochlorothiazide ( P =0.006), doxazosin ( P = 0.001), and bisoprolol ( P =0.039) but not in animals receiving moxonidine ( P =0.122). Compared with pooled BP change of all other drug classes, mean arterial pressure change was largest for olmesartan (−15.9 mm Hg [95% CI, −18.6 to −13.2]; P <0.001) and amlodipine (−12.0 mm Hg [95% CI, −14.7 to −9.3]; P <0.001). In drug-naïve controls, RDN reduced plasma renin activity (−5.6%¸ P =0.03) and aldosterone concentration (−53.0%; P =0.005). In the presence of antihypertensive medication, plasma renin activity and aldosterone remained unchanged after RDN. Cardiac remodeling was not affected by RDN alone. In animals receiving olmesartan after RDN, cardiac perivascular fibrosis was attenuated. Amlodipine and bisoprolol following RDN reduced cardiomyocyte diameter. Conclusions: Following RDN, treatment with amlodipine and olmesartan resulted in the largest BP reduction. Antihypertensive medications mediated heterogeneous effects on renin-angiotensin-aldosterone system activity and cardiac remodeling.

The purpose of this study is to study environmentally friendly human resource management including employee behaviour in the workplace and the environment around the workplace. We used secondary data on 216 companies in Malaysia by conducting online interviews with 2160 employees about human resource and environmental management practices by quantifying them using the Likert scale and analyzing them using the ordinary least square model. We found a positive relationship between the level of environmental and social concern for the organization as reflected in environmentally friendly regulations and Standard Operating Procedures with human resource management as well as the level of employee compliance with company regulations and the level of employee welfare.

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This study analyzes the causality relationship between energy usage, education, health, and CO2 emissions in Indonesia. In a 21-year data analysis from 2000 to 2020, "autoregressive vectors" were used to represent the causal link between variables. The World Bank contributed the data for this research. In this study, we look at investigates the causality link between electricity usage, education, health, and CO2 emissions in Indonesia. We found that energy usage has a significant positive relationship with CO2 emissions, which means that the higher the energy consumption in Indonesia, the more threatened environmental sustainability in Indonesia is. Energy usage also has a negatively impact on the health and education of the Indonesian population. Education itself significantly increases the efficiency of energy use in Indonesia so education plays a crucial function in the efficiency of energy consumption in Indonesia. Health does not have a significant impact on environmental sustainability. Indonesia needs to make energy consumption efficient and protect the environment. The human capital that is enhanced through education is an important factor in maintaining environmental sustainability and energy consumption efficiency in Indonesia.