The paradoxical effect of aldosterone on cardiovascular outcome in maintenance hemodialysis patients

Background Patients with end-stage kidney disease face increased risk of cardiovascular events, and left ventricular diastolic dysfunction (LVDD) contributes to the high occurrence of cardiovascular mortality (CM). Although a high serum aldosterone (sALD) level is involved in the development of cardiovascular complications in the general population, this association is unclear in patients undergoing hemodialysis. We aimed to determine the impact of sALD on LVDD and CM among hemodialysis patients (HDPs). Methods We performed a prospective cohort study of maintenance HDPs without cardiovascular disease. The patients were divided into two groups according to the median level of sALD. All patients underwent baseline echocardiography to evaluate diastolic dysfunction (E/e' ratio > 15). The LVDD and CM rates were compared between the high and low aldosterone groups. Results We enrolled a total of 60 adult patients (mean age, 57.9 ± 12.1 years; males, 30.0%). The low aldosterone group had an increased left ventricular diastolic dimension compared with the high aldosterone group (52.2 ± 8.4 mm vs. 50.3 ± 5.2 mm, respectively; p = 0.03). Low log-aldosterone (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19–0.86) and large left atrial dimension (OR, 1.31; 95% CI, 1.11–1.54) were independent risk factors for LVDD at baseline. In addition, Cox regression analysis demonstrated that low sALD was an independent predictor of CM in HDPs (hazard ratio, 0.46; 95% CI, 0.25–0.85; p = 0.01) during follow-up. Conclusion Low sALD was not only associated with LVDD but was also an independent predictor of CM among HDPs regardless of their interdialytic weight gain

Facing the crucible: Australia, the ROK, and cooperation in Asia

Current developments in Northeast Asia underscore the importance of recent efforts by Australia and South Korea to develop independent security ties. Understanding the rationales and selected benchmarks in Australian-ROK politico-security relations is important to reaching a meaningful assessment of how they could affect regional and international security. The "common wisdom" that the two countries' distance from each other, and that their disparate historical and cultural backgrounds complicate the development of bilateral politico-security ties is contested here. A major challenge that both these "middle powers" will face will be to reconcile their alliances with the United States with their growing economic and political relations with China, particularly in the context of responding to future strategic contingencies on the Korean peninsula

Bridging alliances and Asia-Pacific multilateralism

Since the end of the Cold War, a number of efforts have been made to develop multilateral regional security regimes in the Asia-Pacific. Rapidly changing relationships among regional powers have mandated such efforts to transform that region�s predominantly bilateral security architectures to more comprehensive forms of regional order building. Although bilateral alliances led by the United States have significantly contributed to regional security and stability in Asia for many decades, the very complexity of emerging security issues and threats beyond the parameters of bilateral security politics has become increasingly apparent. To cope with these new challenges, states in the region increasingly realize the imperative of working together to achieve conflict avoidance and regional prosperity. In this context, they have become more interested in forming and sustaining multilateral security arrangements. A variety of multilateral security institutions or organizations have beencreated and maintained in the region, and even more ambitious institutionalization has been proposed. Among the existing organizations are the ASEAN (Association of Southeast Asian Nations) Regional Forum (ARF) launched by ASEAN in 1994, and the more recent East Asia Summit (EAS) founded in 2005. To date, however, neither of these institutions has fully realized the original criteria underscoring their creation � that is, providing a body of norms that would generate consensus and full adherence by their member states and acting decisively to prevent or to intervene in a regional crisis. Accordingly, individual national political leaders in the Asia-Pacific region have advocated that more comprehensive multilateral security institutions be established. In his inaugural address in 2003, South Korean President Roh Moo-hyun declared �the Age of � Northeast Asia� and proposed building a �community of peace and prosperity,� positioning the Korean peninsula as the hub connecting the Eurasian continent and the Pacific Ocean (Roh 2007: 12). Australian Prime Minister Kevin Rudd pushed in 2008 for an �Asia-Pacific Community� that would embrace �the entire Asia-Pacific region � including the United States, Japan, China,India, Indonesia and the other states of the region.� Rudd argued that there was a strong need for a multilateral Asia-Pacific institution to �underpin an open, peaceful, stable, prosperous and sustainable region� (Rudd 2008). Not long after the Asia-Pacific Community initiative was tabled, Japanese Prime Minister Hatoyama Yukio presented his vision of an �East Asian Community� � �countries sharing a common vision [to] promote cooperation in various fields � based on the principle of �open regional cooperation�� (Hatoyama 2009b). Despite these diverse initiatives, various observers have criticized them asbeing largely impractical. Even those who have supported them have tended to view their significance as largely �functional,� reflecting what they view as the somewhat placid style characterizing the �ASEAN way,� � informal, loosely organized, and seldom leading to concrete results (see Narine 1997; Solingen 2005). Such critics often yearn for the infusion of �more European� approaches to Asia-Pacific multilateralism. What is missing in contemporary Asian multilateral security politics, they believe, is a requisite assimilation of those assets found in the more �mature� European security models such as the Organization for Security and Co-operation in Europe (OSCE) or the North Atlantic Treaty Organization�s (NATO) political component that has sustained security on the continent where it is still operating a full two decades after the demise of the Soviet Union (Gilson 2002: 122)

Let developers run into the app store by lowering the barrier-to-entry

An app store has a two-sided market composed of a developer-side and consumer-side. If the developer-side expands, consumers' willingness to access is increased in the app store market. Therefore, we argue that the expansion of the developer-side is one of the key elements for the success of an app store. This paper identifies the variables affecting the expansion of the developer-side such as developers' motives and analyses their impacts on global app stores using the Analytic Network Process (ANP). Finally, this paper briefly discusses the implications of its main findings for the success of an app store in the market.app stores; barriers-to-entry; developer-side; consumer-side; two-sided markets; network effects; analytic network process; motives; globalisation; global markets; Apple Corporation; Korea Telecom; open applications; mobile phones; cell phones; ICT; information technology; communications technology; electronic finance; e-finance.

Geriatric Nutritional Risk Index and First-Year Mortality in Incident Hemodialysis Patients

Objective. The Geriatric Nutritional Risk Index is a simple nutritional screening method, and this study aimed to investigate the association between the initial Geriatric Nutritional Risk Index and all-cause mortality in incident patients in the first year after the initiation of hemodialysis. Materials and Methods. This study is a retrospective cohort study and used the Korean Renal Data System database. Patients who were eligible for Geriatric Nutritional Risk Index assessment and underwent hemodialysis from January 2016 to December 2019 were included. The primary outcome was all-cause mortality, and outcome evaluation was performed in December 2020. A Cox proportional hazard model was used to analyze the association between the Geriatric Nutritional Risk Index and mortality. Results. A total of 10,545 patients were included, and the mean age was 63.9 ± 3.7 years. The patients were divided into four groups by the quartile of the Geriatric Nutritional Risk Index with a mean value of 96.2 ± 8.2. During the study period, 545 (5.2%) deaths occurred. The surviving patients had higher Geriatric Nutritional Risk Index values than ones who died in the first year of hemodialysis initiation (96.6 ± 7.5 vs. 88.2 ± 9.3, p p p p < 0.001). Conclusions. These findings suggest that a low Geriatric Nutritional Risk Index (<91.8) is associated with first-year all-cause and cardiovascular mortality in patients who start hemodialysis and may be a useful and reproducible tool for assessing prognoses in this population

Prediction of vascular access stenosis: Blood temperature monitoring with the Twister versus static intra-access pressure ratio.

BACKGROUND:The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend intra-access flow (Qa) measurement as the preferred vascular access surveillance method over static intra-access pressure ratio (SIAPR). Recently, it has become possible to perform Qa measurement during hemodialysis using thermodilution method called blood temperature monitoring (BTM) with the Twister device. The aim of this study was to investigate the correlation between Qa by BTM and SIAPR and to compare the performance of two tests in prediction of vascular access stenosis. METHODS:The study was performed from January 2016 to November 2017 and included 97 patients with arteriovenous fistulas (AVF). Qa by BTM and SIAPR were simultaneously measured every 1~3 months with a total of 449 measurements during study period. RESULTS:In our study population, mean age was 59.9±10.0 years and 61.9% were diabetes. The mean Qa obtained by BTM was 1186±588 mL/min. There was no correlation between Qa by BTM and venous SIAPR (r = 0.061, P = 0.196). Angiography identified 36 stenotic AVFs (37.1%) among the study subjects. They included 13 cases with only inflow stenosis, 6 with only outflow stenosis, and 17 with stenosis on both sides. Receiver-operating characteristic (ROC) curve analysis showed that Qa by BTM had higher discriminative ability to diagnose vascular access stenosis compared to SIAPR (P <0.001). The Qa less than 583 mL/min showed the highest diagnostic accuracy in vascular stenosis prediction. CONCLUSION:Intradialytic measurement of Qa by BTM showed better diagnostic power over venous SIAPR in prediction of vascular access stenosis