Early utilization of hypertonic peritoneal dialysate and subsequent risks of non-traumatic amputation among peritoneal dialysis patients: a nationwide retrospective longitudinal study

BACKGROUND: The hemodialysis (HD) population has a particularly high incidence of amputation, which is likely associated with decreased tissue oxygenation during HD. However, information about the risk factors leading to amputation in peritoneal dialysis (PD) patients is limited. Here, we have investigated the association between the use of hypertonic peritoneal dialysate (HPD) and subsequent amputation in PD patients. METHODS: Based on the data from the Taiwan National Health Insurance research database, this observational cohort study enrolled 203 PD patients who had received HPD early during treatment and had not undergone amputation and 296 PD controls who had not undergone amputation. Subjects were followed through until the end of 2009 and the event rates of new non-traumatic amputation were compared between groups. RESULTS: The incidence of amputation was 3 times higher for the HPD cohort than for the comparison cohort (23.68 vs. 8.01 per 1000 person-years). The hazard ratio (HR) for this group, estimated using a multivariable Cox model, was 2.48 (95% confidence interval [CI] = 1.06–5.79). The HR for patients with both diabetes and early adoption of HPD increased to 44.34 (95% CI = 5.51-357.03), compared to non-HPD non-diabetic PD controls. CONCLUSION: Early utilization of HPD in PD patients is associated with increasing risk of amputation; this risk considerably increases for those with concomitant diabetes

The role of donor versus recipient tissue factor in coagulopathy during pig-to-primate xenotransplantation

The increasing demand for organs has stimulated the necessity in xenotransplantion, which promises an unlimited supply of organs for clinical use. However, coagulopathy of xenografts remains a major hurdle to successful pig-to-primate xenotransplantation. The ability to generate pigs expressing a human complement-regulatory protein (hCRP) and/or pigs in which the α1,3-Galactosyltransferase gene has been knocked-out (GT-KO) has largely overcome the barrier of hyperacute rejection (HAR) of a pig organ transplanted into a primate. However, acute humoral xenograft rejection (AHXR), presenting as microvascular thrombosis with/without consumptive coagulopathy (CC), ensures and results in graft failure. The causes of coagulopathy were believed to be humoral response-dependent. Xenoreactive antibodies (Abs) and activation of complement provoke porcine endothelial cells (ECs) from an anticoagulant to a procoagulant phenotype. In this study, I demonstrated that recipient platelets and monocytes were activated to express tissue factor (TF), an initiator of the coagulation cascade, after incubation with porcine ECs through humoral immune response-independent process. These observations were mirrored in the animal studies. Kidneys or livers from GT-KO pigs that express a hCRP transplanted into nonhuman primates were not susceptible to HAR. Nevertheless, most recipients developed CC, even when the grafts were still functioning. Activation of graft ECs and the measurable immune response were minimal. TF expression on recipient platelets plays a pivotal role in initiating CC. Therefore, understanding the interactions between porcine ECs and primate platelets may be crucial to prevent coagulopathy. On the other hand, the generation of GT-KO pigs has directed interest to the role of anti-nonGal Abs in intravascular thrombosis. My study revealed that anti-nonGal Abs activated porcine ECs to express TF, independent of complement activation. I also demonstrated that anti-P-selectin and vWF Abs and some anti-platelet agents, such as clopidogrel and eptifibatide, prevented TF expression on platelets after incubation with porcine ECs. Porcine ECs from pigs that expressed tissue factor pathway inhibitor (TFPI) were resistant to the activation induced by primate serum even with high titre anti-nonGal Abs. Atorvastatin not only inhibited this activation of platelets but also prevented the activation of porcine ECs induced by primate serum. Coagulopathy is increasingly recognized as barriers to successful xenotransplantation, many mechanisms of which are not associated with humoral immune response. Further manipulation of the immune response alone, with the risk of inducing infection and other complications, does not appear likely to resolve the challenge of xenograft coagulopathy. My results provide evidence for further genetic manipulation or systemic pharmaceutical treatment to prevent coagupolpathy seen after pig-primate xenotransplantation

Treatment and Prognosis of Hepatitis B Virus Concomitant with Alcoholism

Hepatitis B virus (HBV) infection is a global disease worldwide. The Asia-Pacific region has a high prevalence of viral hepatitis, and Taiwan is a region of high prevalence of chronic hepatitis B (CHB) with increasing alcoholic liver disease. We have investigated the prognosis and treatment of patients with concomitant hepatitis B virus (HBV) infection and alcoholism. The 10-year cumulative incidence of hepatocellular carcinoma (HCC) is much higher in patients with concomitant alcoholism and HBV infection than in those with alcoholism or HBV infection alone. Treatment with antiviral therapy and abstinence may be started in patients with decompensated cirrhosis and compensated cirrhosis with high HBV DNA. In pre-cirrhotic cases, treatment with antiviral therapy and abstinence may be started in patients with persistently elevated ALT levels and high HBV DNA, and significant fibrosis with minimal elevated or normal ALT levels and mild high HBV DNA. Treatment with antiviral therapy and abstinence reduces the incidence of HCC in patients with concomitant HBV infection and alcoholism. In conclusion, patients with concomitant HBV infection and alcoholism have high incidence of cirrhosis, HCC, and mortality. Treatment with antiviral therapy and abstinence may be started to reduce the incidence of cirrhosis, HCC, and mortality in these patients

The development of the job satisfaction scale for hospital staff in Taiwan

The current study attempts to construct a valid and applicable job satisfaction scale for measuring the contentment level of hospital staff in Taiwan. The job description inventory (JDI) and Job Satisfaction Index (JSI) were adopted as the foundation of the job satisfaction measure for hospital staff in a selected hospital. To verify and validate the scale, data collected in 2012 and 2013, were analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. Subsequently, Pearson correlations analysis was used to examine the strength and direction of the relationships between job satisfaction dimensions. Overall, the job satisfaction scale developed in this research illustrated valid and accurate measure for assessing hospital staffs' satisfaction. Both EFA and CFA results demonstrated that items consistently emerged six dimensions i.e. work environment, work achievement, compensation and benefits, education and training, promotion and evaluation, and management system. The findings also highlight that management support, work achievement, and promotion and evaluation are three critical factors that significantly contribute to high levels of job satisfaction for hospital staff

Rate adaptation for 802.11 multiuser mimo networks

In multiuser MIMO (MU-MIMO) networks, the optimal bit rate of a user is highly dynamic and changes from one packet to the next. This breaks traditional bit rate adaptation algorithms, which rely on recent history to predict the best bit rate for the next packet. To address this problem, we introduce TurboRate, a rate adaptation scheme for MU-MIMO LANs. TurboRate shows that clients in a MU-MIMO LAN can adapt their bit rate on a per-packet basis if each client learns two variables: its SNR when it transmits alone to the access point, and the direction along which its signal is received at the AP. TurboRate also shows that each client can compute these two variables passively without exchanging control frames with the access point. A TurboRate client then annotates its packets with these variables to enable other clients to pick the optimal bit rate and transmit concurrently to the AP. A prototype implementation in USRP-N200 shows that traditional rate adaptation does not deliver the gains of MU-MIMO WLANs, and can interact negatively with MU-MIMO, leading to low throughput. In contrast, enabling MU-MIMO with TurboRate provides a mean throughput gain of 1.7x and 2.3x, for 2-antenna and 3-antenna APs respectively.National Science Council (China) (contract No. NSC 100-2221-E-001-005-MY2)National Science Foundation (U.S.) (NSF Grant CNS-1117194

The Relationships among Buyers’ Perceived Risk, Exhibitors’ Brand Equity, Purchase Postponement and Switching Intention-From the Perspectives of Perceived Risk Theory and Expectancy Theory

This study explores the effects of buyers’ perceived risk on their purchase postponement and switching intention in an international industrial fair, as well as examines the moderating effect of exhibitors’ brand equity on the above relationships. This study uses the purposive sampling method to survey buyers of the famous International Woodworking Machine Fair in Hanover, Germany. Of the 200 surveys distributed, 105 valid questionnaires were returned, representing a response rate of 52.50%. Analytical results show that higher buyers’ perceived risk is associated with buyers’ higher purchase postponement, and stronger switching intention. Furthermore, when facing high-brand equity exhibitors’ products, if buyers perceive low risk of use, they are unlikely to delay purchase and switch suppliers; in contrast, if they perceive high risk of use, they are more likely to delay purchase and switch suppliers. Finally, when buyers face low-brand equity exhibitors’ products, if they perceive low risk of use, they will delay purchase and switch suppliers; in contrast, if they perceive high risk of use, they will tend not to delay purchase and switch suppliers

Idiopathic Superior Mesenteric Vein Thrombosis Resulting in Small Bowel Ischemia in a Pregnant Woman

Background. Small bowel ischemia due to superior mesenteric vein thrombosis (MVT) is rare during pregnancy. However, additional precipitating factors should usually be identified. Case. A 31-year-old woman, pregnant at 34 weeks, was sent to the emergency department because of acute peritonitis. An emergency exploration revealed a segmental gangrene of the small intestine without any mechanical obstruction. Together with the termination of pregnancy, resection of the damaged small bowel was performed, and an end-to-end enterostomy was followed. Based on the operative and pathological findings, small bowel ischemia might be attributed to superior mesenteric vein thrombosis. Conclusion. Hypercoagulation state normally found in pregnant women is believed to lead to this catastrophic condition without other precipitating factors

Inhibition of yes-associated protein suppresses brain metastasis of human lung adenocarcinoma in a murine model.

Yes-associated protein (YAP) is a main mediator of the Hippo pathway and promotes cancer development and progression in human lung cancer. We sought to determine whether inhibition of YAP suppresses metastasis of human lung adenocarcinoma in a murine model. We found that metastatic NSCLC cell lines H2030-BrM3(K-rasG12C mutation) and PC9-BrM3 (EGFRΔexon19 mutation) had a significantly decreased p-YAP(S127)/YAP ratio compared to parental H2030 (K-rasG12C mutation) and PC9 (EGFRΔexon19 mutation) cells (P < .05). H2030-BrM3 cells had significantly increased YAP mRNA and expression of Hippo downstream genes CTGF and CYR61 compared to parental H2030 cells (P < .05). Inhibition of YAP by short hairpin RNA (shRNA) and small interfering RNA (siRNA) significantly decreased mRNA expression in downstream genes CTGF and CYR61 in H2030-BrM3 cells (P < .05). In addition, inhibiting YAP by YAP shRNA significantly decreased migration and invasion abilities of H2030-BrM3 cells (P < .05). We are first to show that mice inoculated with YAP shRNA-transfected H2030-BrM3 cells had significantly decreased metastatic tumour burden and survived longer than control mice (P < .05). Collectively, our results suggest that YAP plays an important role in promoting lung adenocarcinoma brain metastasis and that direct inhibition of YAP by shRNA suppresses H2030-BrM3 cell brain metastasis in a murine model