Coronary artery disease in dialysis patients: What is the optimal therapy?

AbstractCoronary artery disease (CAD) carries a high risk of mortality in dialysis patients. End-stage renal disease is considered to increase the vulnerability of patients with atherosclerosis superimposed on artery calcification. Recently, an increasing prevalence of CAD in dialysis patients has been attributed to a lack of effective prevention and treatment. Further studies have shown that optimal therapies for CAD in dialysis patients remain neglected and unclarified. These therapies include correction of anemia, control of blood pressure, and antiplatelet therapy. Because of bleeding tendencies in dialysis patients, the benefits of antiplatelet therapy and platelet glycoprotein IIb/IIIa inhibitors for treating CAD require more research. In addition, a meta-analysis of retrospective studies in 2012 showed that dialysis patients with CAD receiving coronary artery bypass surgery had a lower long-term mortality rate and fewer postoperative cardiac complications than those receiving percutaneous coronary angioplasty. A large randomized, long-term cohort study is necessary to confirm these issues

The effects of rear-wheel camber on the kinematics of upper extremity during wheelchair propulsion

BACKGROUND: The rear-wheel camber, defined as the inclination of the rear wheels, is usually used in wheelchair sports, but it is becoming increasingly employed in daily propulsion. Although the rear-wheel camber can increase stability, it alters physiological performance during propulsion. The purpose of the study is to investigate the effects of rear-wheel cambers on temporal-spatial parameters, joint angles, and propulsion patterns. METHODS: Twelve inexperienced subjects (22.3±1.6 yr) participated in the study. None had musculoskeletal disorders in their upper extremities. An eight-camera motion capture system was used to collect the three-dimensional trajectory data of markers attached to the wheelchair-user system during propulsion. All participants propelled the same wheelchair, which had an instrumented wheel with cambers of 0°, 9°, and 15°, respectively, at an average velocity of 1 m/s. RESULTS: The results show that the rear-wheel camber significantly affects the average acceleration, maximum end angle, trunk movement, elbow joint movement, wrist joint movement, and propulsion pattern. The effects are especially significant between 0° and 15°. For a 15° camber, the average acceleration and joint peak angles significantly increased (p < 0.01). A single loop pattern (SLOP) was adopted by most of the subjects. CONCLUSIONS: The rear-wheel camber affects propulsion patterns and joint range of motion. When choosing a wheelchair with camber adjustment, the increase of joint movements and the base of support should be taken into consideration

Online platform for applying space–time scan statistics for prospectively detecting emerging hot spots of dengue fever

Abstract Background Cases of dengue fever have increased in areas of Southeast Asia in recent years. Taiwan hit a record-high 42,856 cases in 2015, with the majority in southern Tainan and Kaohsiung Cities. Leveraging spatial statistics and geo-visualization techniques, we aim to design an online analytical tool for local public health workers to prospectively identify ongoing hot spots of dengue fever weekly at the village level. Methods A total of 57,516 confirmed cases of dengue fever in 2014 and 2015 were obtained from the Taiwan Centers for Disease Control (TCDC). Incorporating demographic information as covariates with cumulative cases (365 days) in a discrete Poisson model, we iteratively applied space–time scan statistics by SaTScan software to detect the currently active cluster of dengue fever (reported as relative risk) in each village of Tainan and Kaohsiung every week. A village with a relative risk >1 and p value <0.05 was identified as a dengue-epidemic area. Assuming an ongoing transmission might continuously spread for two consecutive weeks, we estimated the sensitivity and specificity for detecting outbreaks by comparing the scan-based classification (dengue-epidemic vs. dengue-free village) with the true cumulative case numbers from the TCDC’s surveillance statistics. Results Among the 1648 villages in Tainan and Kaohsiung, the overall sensitivity for detecting outbreaks increases as case numbers grow in a total of 92 weekly simulations. The specificity for detecting outbreaks behaves inversely, compared to the sensitivity. On average, the mean sensitivity and specificity of 2-week hot spot detection were 0.615 and 0.891 respectively (p value <0.001) for the covariate adjustment model, as the maximum spatial and temporal windows were specified as 50% of the total population at risk and 28 days. Dengue-epidemic villages were visualized and explored in an interactive map. Conclusions We designed an online analytical tool for front-line public health workers to prospectively detect ongoing dengue fever transmission on a weekly basis at the village level by using the routine surveillance data

Weakness of shim¡¦s New ID-based tripartite multiple-key agreement protocol

In this article we show that Shim¡¦s new ID-based tripartite multiple-key agreement protocol still suffers from the impersonation attack, a malicious user can launch an impersonation attack on their protocol

Nonmagnetic impurity perturbation to the quasi-two-dimensional quantum helimagnet LiCu2O2

A complete phase diagram of Zn substituted quantum quasi-two-dimensional helimagnet LiCu2O2 has been presented. Helical ordering transition temperature (T_h) of the original LiCu2O2 follows finite size scaling for less than ~ 5.5% Zn substitution, which implies the existence of finite helimagnetic domains with domain boundaries formed with nearly isolated spins. Higher Zn substitution > 5.5% quenches the long-range helical ordering and introduces an intriguing Zn level dependent magnetic phase transition with slight thermal hysteresis and a universal quadratic field dependence for T_c (Zn > 0.055,H). The magnetic coupling constants of nearest-neighbor (nn) J1 and next-nearest-neighbor (nnn) J2 (alpha=J2/J1) are extracted from high temperature series expansion (HTSE) fitting and N=16 finite chain exact diagonalization simulation. We have also provided evidence of direct correlation between long-range helical spin ordering and the magnitude of electric polarization in this spin driven multiferroic material

Neonatal-Onset Chronic Intestinal Pseudo-Obstruction Syndrome with In Utero Urological Manifestation as Megacystis

SummaryObjectiveWe describe a case of neonatal-onset chronic intestinal pseudo-obstruction syndrome (CIPS) with in utero urological manifestation as congenital megacystis. Pitfalls in the interpretation of prenatal sonographic appearance, genetic counseling, and differential diagnosis are discussed.Case ReportA 28-year-old Taiwanese woman, gravida 6, para 3, was referred for further sonographic examination because of a suspected fetal abdominal cyst. Targeted ultrasound at 28 weeks' gestation showed megacystis filling the abdominal cavity. The renal parenchyma appeared normal, and there was no evidence of reflux hydroureteronephrosis. At 38 weeks of gestation, the patient spontaneously delivered a female infant weighing 3,350 g with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. At the age of 12 days, the infant still required Foley catheterization because of voiding difficulty, so reduction cystoplasty was performed. The infant presented with recurrent episodes of intestinal obstruction thereafter and underwent ileostomy and resections of segmental intestine loops (3 times) in the ensuing years. At the age of 6 years, she is orally fed with partial parenteral infusion support, and the voiding act is satisfactory.ConclusionAttention should be given to the prenatal diagnosis of neonatal-onset CIPS when fetal congenital megacystis with unknown etiology is first detected. Whether there is any relationship between the megacystismicrocolon-intestinal-hypoperistalsis syndrome, CIPS, and pure congenital megacystis requires further study

Xanthohumol, a Prenylated Flavonoid from Hops (Humulus lupulus), Prevents Platelet Activation in Human Platelets

Xanthohumol is the principal prenylated flavonoid in the hop plant (Humulus lupulus L.). Xanthohumol was found to be a very potent cancer chemopreventive agent through regulation of diverse mechanisms. However, no data are available concerning the effects of xanthohumol on platelet activation. The aim of this paper was to examine the antiplatelet effect of xanthohumol in washed human platelets. In the present paper, xanthohumol exhibited more-potent activity in inhibiting platelet aggregation stimulated by collagen. Xanthohumol inhibited platelet activation accompanied by relative [Ca2+]i mobilization, thromboxane A2 formation, hydroxyl radical (OH●) formation, and phospholipase C (PLC)γ2, protein kinase C (PKC), mitogen-activated protein kinase (MAPK), and Akt phosphorylation. Neither SQ22536, an inhibitor of adenylate cyclase, nor ODQ, an inhibitor of guanylate cyclase, reversed the xanthohumol-mediated inhibitory effect on platelet aggregation. Furthermore, xanthohumol did not significantly increase nitrate formation in platelets. This study demonstrates for the first time that xanthohumol possesses potent antiplatelet activity which may initially inhibit the PI3-kinase/Akt, p38 MAPK, and PLCγ2-PKC cascades, followed by inhibition of the thromboxane A2 formation, thereby leading to inhibition of [Ca2+]i and finally inhibition of platelet aggregation. Therefore, this novel role of xanthohumol may represent a high therapeutic potential for treatment or prevention of cardiovascular diseases