Study of relationship between serum magnesium and carotid atherosclerosis in hemodialysis versus non-hemodialysis dependent CKD patients

Background: Cardiovascular diseases are the most important causes of morbidity and mortality in CKD mainly due to accelerated atherosclerosis. Mg2+ possesses an anti-atherosclerotic effect, because of its anti-inflammatory and antioxidant properties. Mg2+ deficiency promotes hydroxyapatite formation and calcification of VSMC thus leading to accelerated plaque formation. To evaluate relationship between serum Mg2+ level and atherosclerotic changes in CKD patients who are hemodialysis dependent versus who have not undergone hemodialysis. Methods: This hospital based observational cross-sectional study has been carried out in Department of K.P.S Institute of Medicine, GSVM Medical College, Kanpur.58 subjects (29 being dialysis dependent and other 29 who have not undergone dialysis sessions yet. All the subjects underwent routine tests and intima media thickness (IMT) of carotid artery was measured via Doppler study. Results: In our study the mean value of Mg was 2.25 mg/dl + 0.81 with 17 patients had hypomagnesemia. IMT of carotid artery with a mean value of 0.91mm + 0.24, was found to be increased in 16 patients, these were the patients who were on hemodialysis and had lower magnesium levels. Serum Mg2+ was negatively correlated (Pearson correlation coefficient was -0.677 and -0.704) with CIMT with statistical significance as (P<0.001) , only in patients who have underwent series of hemodialysis sessions. Conclusions: We concluded that serum Mg might be considered as a modifiable risk factor of atherosclerosis (and thus, cardiovascular mortality) in Hemodialysis dependent CKD patients

An improved sliding mode control (SMC) approach for enhancement of communication delay in vehicle platoon system

Vehicle platoon systems are widely recognized as a key enabler to address mass-transport. Vehicle-to-Vehicle (V2V) and Vehicle-to-Infrastructure (V2I) are two technologies that drive platooning. The inter-vehicle spacing and the collaboration velocity in the platoon are main important parameters that must be controlled. Recently, a new mass-transport system has been proposed, called the Tracked Electric Vehicles (TEV). In TEV, the inter-vehicular spacing is reduced to only a quarter of the regular car length and cars drive at 200km/h which enable mass transport at uniform speed. However, conventional radar based Adaptive Cruise Control (ACC) system fail to control each vehicle in these scenarios. Lately, Sliding Mode Control (SMC) has been applied to control platoons with communication technology but with low speed and without delay. This paper proposes a novel SMC design for TEV using global dynamic information with the communication delay. Also, graph theory has been employed to investigate different V2V communication topology structures. To address the issues of node vehicle stability and string stability, Lyapunov candidate function is chosen and developed for in-depth analysis. In addition, this paper, uses first-order vehicle models with different acceleration and deceleration parameters for simulation validations under communication delay. The results show that this novel SMC has a significant tolerance ability therefore meet the design requirements of TEV

Diagnostic implication of mean platelet volume in thrombocytopenia

Background: A well-known cause of thrombocytopenia is peripheral platelet destruction in which the circulating platelets are premature and large. Many times a bone marrow examination is conducted to find out the etiology of thrombocytopenia. Assessment of platelet parameters like mean platelet volume (MPV) generated by a hematology analyzer is also believed to be helpful for guiding the clinicians to identify such cases. Aims: This study aims to ascertain whether raised MPV correlates with thrombocytopenia due to hyperdestruction of platelets. Materials and Methods: This was 2 years unicentric prospective observational study which included 100 thrombocytopenic patients. Their clinical diagnosis, platelet counts, and MPV values were recorded. Peripheral blood smears (PBS) were also examined for megaplatelets. Each case was put in Group A (hyperdestructive etiology) or Group B (hypoproductive etiology). Results: Group A had 79 cases out of which 53 had an MPV value more than 10.5 fl. In the rest, although MPV was not prominently raised, the PBS did show megaplatelets. Group B had 21 cases, which were not associated with a high MPV. A receiver operating characteristic curve was plotted, and Youden's index was used to find out a cutoff value for MPV (8.5 fl) which gave the maximum sensitivity and specificity to discriminate thrombocytopenia cases of hyperdestructive etiology from the rest. Conclusion: MPV is an accurate, reliable, and easily obtained platelet parameter which is helpful in diagnosing the basic etiology of thrombocytopenia. It is also a less painful alternative than the bone marrow examination for the patient

A single-cell transcriptomic atlas characterizes ageing tissues in the mouse

Ageing is characterized by a progressive loss of physiological integrity, leading to impaired function and increased vulnerability to death1. Despite rapid advances over recent years, many of the molecular and cellular processes that underlie the progressive loss of healthy physiology are poorly understood2. To gain a better insight into these processes, here we generate a single-cell transcriptomic atlas across the lifespan of Mus musculus that includes data from 23 tissues and organs. We found cell-specific changes occurring across multiple cell types and organs, as well as age-related changes in the cellular composition of different organs. Using single-cell transcriptomic data, we assessed cell-type-specific manifestations of different hallmarks of ageing-such as senescence3, genomic instability4 and changes in the immune system2. This transcriptomic atlas-which we denote Tabula Muris Senis, or 'Mouse Ageing Cell Atlas'-provides molecular information about how the most important hallmarks of ageing are reflected in a broad range of tissues and cell types

Single-cell transcriptomics of 20 mouse organs creates a "Tabula Muris"

Here we present a compendium of single-cell transcriptomic data from the model organism Mus musculus that comprises more than 100,000 cells from 20 organs and tissues. These data represent a new resource for cell biology, reveal gene expression in poorly characterized cell populations and enable the direct and controlled comparison of gene expression in cell types that are shared between tissues, such as T lymphocytes and endothelial cells from different anatomical locations. Two distinct technical approaches were used for most organs: one approach, microfluidic droplet-based 3'-end counting, enabled the survey of thousands of cells at relatively low coverage, whereas the other, full-length transcript analysis based on fluorescence-activated cell sorting, enabled the characterization of cell types with high sensitivity and coverage. The cumulative data provide the foundation for an atlas of transcriptomic cell biology

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction